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Some  fallacies  conce 


5!«e«feSK»U!«^NN^na^>^<ew«ss««B^!^bi:^' 


.cies  Concerning  Syphilis, 


E.  L.  Keyes,  M.  D., 


Columbia  ®nifaersitp^ 

intteCitpofjaetogorfe 

COLLEGE  OF  PHYSICIANS 
AND   SURGEONS 


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THE  FAIEOHILD  PREPAEATIONS 


—  OS^ 


THE  POM  mmm  mum, 

Active,  Permanent  and  Reliable. 


TRYPSIN 

(fairchild) 

Especially  Prepared  as  a  Solvent  for 
Diphtheritic  Membrane. 


PEPTONISING  TUBES. 

(fairchild). 

Foi     the  preparation   of  PEPTO- 
NIZED MILK  and  other 
predigested  food  for 
the   sick. 


PEPSINE   IN  SCALES. 

(fairchild). 

The  most  active,  permanent  and  re- 
liable pepsine  made  in  the  World. 


ESSENCE  OF  PEPSINE 

(fairchild). 

For  administration    where   a  fluid 
and  agreeable  form  of  pepsine  is 
desired^  and  for  the  prepara- 
tion  of  Junket    and 
Whey. 


EXTRACTUM  PANCREATIS. 

(fairchild). 

Containing  all  the  digestive  ferments 
of  the  Pancreas. 


PEPTOGENIC  MILK  POWDER 

(fairchild). 

For  the  modification  of  cows'  milk 

to  the  standard  of  Normal 

Mother's  Milk. 


PEPSINE  IN  POWDER. 

(fairchild). 

Prepared  from  the  scales  without  the 
admixture   of  any   other  sub- 
stances, to  facilitate  dis- 
pensing and  the  pre- 
paration of  saccharated pepsine. 


DIASTASIC    ESSENCE   OF 
PANCREAS. 

(fairchild). 

For  the    digestion  of  starchy  foods. 


Fairchild  Bros.  &   Foster, 

82  AND  84  FULTON  ST.  NEW  YORK. 


SOME      FALLACIES 


—  BY 


E.     L.     KEYES,     M.    D., 

Consulting    Surgeon     to   Bellevue,    Charity,    St.    Elizabeth's,    and  Skin 

and  Cancer  Hospitals  of  New   York;  Professor  Genito-Urinary 

Surgery,  Syphilography  and  Dermatology.  Bellevue 

Hospital  Medical  College  (j8j4  to  i8&)). 


1890. 
GEORGE  S.  DAVIS, 

D«TROIT,   MICH. 


Copyrighted  by 
GEORGE  S.  DAVIS. 

1890. 


Some  Fallacies  Concerning  Syphilis. 


1. 

Syphilis  is  necessarily  a  severe  disorder,  disfiguring  its  posses- 
sor, entailing  social  ostracism,  destroying  the  domestic 
life  of  its  victim,  and  impressing  its  stamp  upon  his  issue 
from  generation  to  generation. 

2. 

There  are  essential  differences  in  the  quality  of  the  syphilitic 
poison — in  other  words,  there  is  a  mild  and  a  virulent 
syphilis,  per  se. 

S. 

A  local  sore  appeari  g  upon  the  penis  after  sexual  exposure, 
necessarily  means  that  a  poisoning  of  some  sort  has  been 
experienced,  while  a  recurrence  of  sores  upon  the  penis 
without  further  exposure  is  proof  positive  of  syphfiis. 


Syphilis  is  at  first  a  local  disorder,  capable  of  modification  by 
local  treatment. 

Syphilis  is  acquired  only  during  sexual  contact,  and  is  conta- 
/       gious  only  through  that  channel. 

6. 

A  person  with  svphilis  is  so  poisoned  that  he  may  communi- 
cate the  malady  by  any  contact  of  his  body  with  that  of 
another. 


VI. 

7. 

Mercury  is  an  evil  only  less  serious  than  syphilis  itself,  and  to 
be  accepted  in  the  treatment  of  syphilis  on  the  same 
ground  that  one  would  advocate  jumping  from  a  high 
window  in  order  to  escape  from  a  burning  building. 

8. 

Mercury,  when  used  by  the  method  called  "  the  tonic  treat- 
ment," effects  a  cure  by  virtue  of  its  tonic  action. 

9. 
Mercury  cures  syphilis. 

10. 

The  iodides  are  less  harmful,  and  as  effective,  in  the  treatment 
of  syphilis,  as  mercuiy. 

i  1. 

The  treatment  of  syphilis  consists  only  in  the  use  of  mercury 
and  the  iodides. 

12. 

Syphilis  in  the  parent  often  shows  itself  as  scrofula  in  the 
children. 

13. 

The  Hot  Springs  of  Arkansas  have  some  specific  effect  in 
modifying  the  syphilitic  poison,  curing  the  disease,  or  at 
least  shortening  its  duration. 


PREFACE. 


I  have  thrown  together  the  following  thirteen  fallacies 
which  I  find  to  be  entertained,  to  a  greater  or  less  extent — by 
the  profession  or  the  public,  as  the  case  may  be — for  the  pur- 
pose of  making  a  running  commentary  upon  them,  with  a  view 
to  help  to  spread  abroad  what  seem  to  me  to  be  correct  views. 
If  I  differ  anywhere  from  what  others  believe,  I  am  willing  to 
be  held  responsible.  My  opinions  are  stated  without  reserve, 
and  they  are  honest  ones. 


I  Park  Ave.,  Oct.  14th,  1889. 


E.  L.  KEYES. 


SOME  FALLACIES  CONCERNING  SYPHILIS. 


FALLACY  NO.   I. 

Syphilis  is  necessarily  a  severe  disorder,  disfiguring  its  pos- 
sessor, entailing  social  ostracism,  destroying  the  domestic 
life  of  its  victim,  and  impressing  its  stamp  upon  its  issue 
from  generation  to  generation. 

There  is  an  Eastern  saying  that  runs  somewhat 
in  this  wise:  "Whenever  you  mount  your  horse,  do 
so  with  a  prayer  upon  your  lips,  for  the  grave  lies 
open  before  you."  Yet  who  would  venture,  out  of 
this  sententious  crystallization  of  an  obvious  truth,  to 
evolve  the  broad  generalization  that  equestrianism  is 
a  fatal  exercise. 

It  is  from  generalizations  like  this  that  syphilis 
has  suffered.  Syphilis  is  indeed  a  picturesque  malady, 
full  of  surprises;  occasionally  startling  us  by  the 
severity  of  its  developments,  and  often  doing  some 
thing  that  is  unexpected.  Yet  on  the  whole,  in  the 
whole,  in  the  present  day  and  generation,  in  this 
country,  it  is  far  from  being  the  severe  malady  which 
it  is  reputed  to  be  generally,  among  the  laity,  and 
largely  by  the  profession. 

On  the  contrary,  cases  that  are  carefully  watched 
and  properly  handled,  as  a  rule  do  very  well,  and  the 


disease  has  gained  probably  more  credit  for  medical 
skill  than  most  other  maladies,  on  account  of  the 
facility  with  which  its  symptoms  may  be  managed  by 
appropriate  medication. 

Those  who  see  much  of  syphilis,  undoubtedly, 
have  learned  that  it  is  not,  usually,  a  disastrous  dis- 
ease. But  it  has  been  my  unfortunate,  (perhaps,)  ex- 
perience to  see  so  many  young  men  who,  when  they 
find  themselves  to  be  the  victims  of  this  malady,  feel 
that  they  have  lost  all  hope  of  success  in  life,  and  that 
their  malady  practically  ostracises  and  places  them 
beyond  the  pale  of  polite  society,  making  them  feel 
as  though  when  they  appear  someone  should  go 
in  front  of  them  and  cry  out  unclean,  that  I  cannot 
fail  to  signalize  this  as  one  of  the  special  fallacies  by 
which  the  disease  is  misjudged  and  to  raise  my  voice 
against  it  for  what  it  is  worth. 

As  for  the  mortality  of  the  disease  Dr.  Van 
Buren,  my  late  associate,  has  often  expressed  to  me 
the  opinion  that  gonorrhoea,  indirectly,  is  more  often 
the  cause  of  death  than  is  syphilis;  and  when  we  con- 
sider the  far-reaching  influence  of  gonorrhoea,  notably 
its  effects  upon  the  Fallopian  tubes  in  the  other  sex, 
and  its  indirect  effect  upon  the  issue  of  those  who 
come  under  its  influence,  and  when  we  reflect  that 
bladder  and  kidney  disease  often  arise  as  a  direct  con- 
sequence of  a  gonorrhoea  which  has  resulted  in  stric- 
ture, one  may  appreciate  why  this  conclusion  is 
capable  of  being  sustained  upon  rational  grounds. 


—  3  — 

But  even  allowing  that  such  a  statement  is  over- 
drawn, it  is,  I  believe,  certain  that,  considering  its  rela- 
tive gravity,  syphilis  has,  very  often,  little  to  do  with 
terminating  the  life  of  the  individual  who  possesses  it. 
On  the  contrary,  he  generally  lives  out  his  term  and 
dies  of  some  disorder  entirely  independent  of  the  one 
in  question. 

Some  insurance  companies  have  adopted  this 
conclusion,  and  placed  patients  who  have  had  syphilis 
and  been  treated  by  mercury  for  a  sufficient  period, 
after  a  certain  number  of  years  have  elapsed,  upon 
the  same  footing  in  rating  the  risk,  with  other  individ- 
uals who  have  not  had  the  malady. 

As  for  the  personal  disfigurement  of  syphilitic 
patients,  I  believe  that  the  public  greatly  over-rate 
the  risk  of  this  misfortune. 

Syphilitic  patients,  regularly  seen  and  systemat- 
ically treated,  as  a  rule,  escape  all  permanent  physical 
blemishes;  and,  although  this  rule  has  its  exceptions, 
and  the  exceptions  are  sometimes  undoubtedly  very 
brilliant,  nevertheless,  as  a  rule,  I  think  it  is  capable 
of  abundant  demonstration. 

The  social  status  also  of  the  syphilitic  individual 
is  influenced  almost  entirely  from  moral  considera- 
tions. He  exagerates  the  possibilities  of  his  dis- 
order, and,  fearing  disclosure,  denies  himself  to  a 
certain  extent  to  society,  and  often  runs  away  from 
his  associates  during  the  eruptive  period,  feeling  that 
they  will  see  v/hat  he  knows,  and  that  his  disease  is 


written  out  as  plainly  upon  his  face  as  it  is  in  his 
mind.  That  this  fear  is  an  expression  of  morbid  self- 
consciousness  is  clearly  demonstrated  by  the  faithful 
wife,  who  has  acquired  syphilis  from  her  husband  and 
is  unconscious  of  the  fact.  Innumerable  instances  of 
this  sort  might  be  cited,  where  the  patient  has  passed 
through  her  entire  disorder,  perfectly  ignorant  of  its 
nature,  attending  to  her  duties  and  mingling  with  her 
associates  as  usual,  without  any  of  that  unnatural 
sensitiveness  which  is  felt  by  the  possessor  of  the 
malady  who  has  acquired  it  in  a  guilty  manner. 

Finally,  regarding  the  alleged  transmission  of  the 
taint  from  one  generation  to  another,  in  this  par- 
ticular, also,  I  believe  that  the  public  estimate  is 
vastly  in  excess  of  the  truth. 

Many  years  ago,  when  I  was  much  younger  in 
my  knowledge  of  this  malady  than  I  am  at  present,  I 
counted  the  children  of  young  men  who  had  passed 
through  their  syphilitic  course  under  my  observation, 
and  counted  over  a  hundred  children,  their  issue, 
none  of  whom  presented  any  evidence  of  an  acquired 
syphilitic  taint. 

I  can  make  the  same  remark  to-day.  The  num- 
ber of  children  I  hesitate  even  to  guess  at,  but  it  is 
very  considerable. 

I  never  have  seen  a  syphilitic  child  born  from  a 
syphilitic  father,  where  the  mother  remained  healthy, 
when  the  child  was  conceived  after  the  beginning  of 
the  fifth  year  from  chancre,  and  when  the  patient  had 


—  5  — 
been  treated  systematically  by   mercury   for   a   pro- 
longed period. 

As  for  inheritance  in  the  third  generation,  I  do 
not  believe,  from  my  own  observation,  that  it  ever  oc- 
curs. Two  or  three  isolated  cases  are  on  record 
which  endeavor  to  uphold  the  possibility  of  second- 
hand transmission,  but  in  any  case  it  would  take  more 
than  two  or  three  exceptions  to  upset  an  established 
rule,  and  even  the  exceptions  are  mostly  observed  in 
a  manner  which  does  not  carry  conviction  with  it. 

If  all  these  foregoing  views  appear  more  rose- 
colored  than  is  sustained  by  the  actual  fact,  I  can 
only  remark  in  justifica,tion  that  I  have  made  my  state- 
ments in  a  rather  pronounced  manner  because  my  ob- 
ject is  to  contravert  a  fallacy,  and  the  one  picture 
should  be  as  well  defined  as  the  other.  Yet,  candidly, 
I  believe  my  statements  are  accurate  for  the  vast 
majority  of  instances,  and  it  has  been  my  happy  ex- 
perience to  feel  gratified  with  my  general  policy  of 
having  encouraged  syphilitic  patients  in  the  belief 
that  the  amount  of  suffering  they  are  to  experience 
will  be  largely  in  accordance  with  their  own  conduct; 
and  the  result  has. justified  my  convictions  more  often 
th^n  the  contrary. 

Syphilis  is  a  serious  malady  in  two  senses.  The 
possibility  of  severe  and  unexpected  outbreaks  during 
the  activity  of  the  malady,  and  the  uncertainty  as  to 
obscure  internal  and,  often,  serious  disorder,  (possibly 
fatal),  affecting   the  viscera,  notably    the   brain   and 


spinal  cord  late  in  the  disease,  long  after  all  surface 
manifestations  have  ceased. 

This  latter  is  the  one  grave  aspect,  the  other  is 
the  annoying  one;  namely,  the  unceasing  tendency  to 
relapse,  observed  in  a  certain  fair  majority  of  the 
cases,  the  annoyance  created  by  everlastingly  recur- 
ring mucous  patches  and  other  mouth  symptoms,  the 
pertinacity  with  which  such  sets  of  symptoms  remain 
as  localized  cutaneous  lesions  and  some  localized  af- 
fections of  bone,  which  resist  treatment  and  persist  for 
a  very  long  period,  to  the  great  distress  of  the  pa- 
tient and  annoyance  of  the  physician. 

The  shattered  constitutions,  wrecks  of  life,  found 
in  the  course  of  syphilitic  disease,  where  the  internal 
organs  have  been  permanently  damaged,  the  bones  of 
the  nose  and  throat  or  other  portions  of  the  skeleton 
seriously  compromised,  where  cachexia  and  general 
failure  of  all  the  vital  organs  have  resulted,  where 
paretic  and  paralytic  symptoms,  unevenly  distribu- 
ted, have  made  life  a  burden, — all  these  distressing 
evidences  of  the  severity  of  the  disease  are  constantly 
encountered,  yet  their  number  is  not  great 
when  compared  with  that  of  the  enormous  mul- 
titude, who  may  be  claimed,  legitimately,  by  syphilis 
as  its  victims,  and  who  have  yet  escaped  any  perman- 
ent damage. 

As  a  rule  also,  other  things  being  equal,  the  pa- 
tient is  often  more  responsible  for  the  severity  of  his 
attack  than  any  other  one  influence. 


Over-excited,  at  the  beginning,  his  zeal  expends 
itself,  and  when  he  finds  that  his  malady  does  not 
amount  to  as  much  as  he  supposed  it  would,  he  yields 
to  irregularities  of  life,  neglects  his  treatment,  in- 
dulges again  in  dissipation,  and  thus  draws  down  up- 
on himself  a  revenge  which  he,  afterwards,  is  liable  to 
ascribe  to  the  natural  malignancy  of  the  disease,  or  to 
the  inefficiency  of  the  physician  who  had  its  treatment 
in  charge. 

A  given  syphilis  may  be  malignant  in  the  case  of 
an  individual  who  leads  an  exemplary  life,  but  many 
cases  that  would  have  undoubtedly  been  mild,  become 
severe  through  the  carelessness,  the  viciousness,  or  the 
indifference  of  the  possessor. 


FALLACY  NO.   IL 

There  are  essential  differences  in  the  quality  of  the  syphilitic 
poison — in  other  words,  there  is  a  mild  and  a  virulent 
syphilis  per  se. 

This  fallacy  seems  to  have  a  pretty  strong  hold 
upon  the  lay  community,  I  find  myself  quite  fre- 
quently confronted  by  the  question  as  to  whether 
syphilis  in  a  given  case  is  of  a  severe  type  or  not, 
my  answer  being  expected  to  be  influenced  by  the 
source  from  which  the  poison  has  been  derived. 

My  personal  belief  is,  that  this  is  not  generally  a 
matter  of  the  least  importance.  There  is  but  one 
syphilis;  like  the  sun,  it  shines  for  all;  but  its  effect 
is  different  according  to  the  soil  upon  which  it  germi- 
nates. People  have  an  idea  that  there  is  some 
especial  virulence  naturally  attaching  to  the  acquisi- 
tion of  syphilis  in  China,  in  South  America,  in  Cen- 
tral America,  or  elsewhere;  but,  with  a  slight  reserve 
on  a  certain  ground  which  I  shall  presently  allude  to, 
I  do  not  believe  that  this  difference  exists  as  a  matter 
of  fact. 

I  have  frequently  observed  a  very  mild  syphilis 
which  has  been  derived  from  a  source  of  excessive 
virulence,  and,  on  the  other  hand,  many  instances  in 
which  the  type  of  the  disease  has  been  severe  where 
the  source  from  which  it  has  been  derived  is  found  to 
be  exceedingly  mild. 

My  belief  is,  that  the  physical  peculiarity  of  an 


—  9  — 

individual,  so  far  as  regards  his  aptitude  for  syphilitic 
cultivation,  shows  itself  up  when  the  poison  is  ac- 
quired; and  that  the  virulence  of  the  disease  depends 
more  upon  the  physical  status,  as  to  syphilis,  of  the 
individual  who  acquires  it,  than  it  does  upon  the 
source  from  which  he  derives  it. 

What  this  physical  peculiarity  is,  I  do  not  know. 
It  is  not  necessarily  a  depraved  constitution.  It  is 
not,  apparently,  the  possession  of  the  scrofulous, 
tubercular,  or  the  rheumatic  diathesis.  Other  things 
being  equal,  patients  with  these  additional  tendencies 
to  physical  deterioration  might  be  expected  to  show 
up  unfavorably  under  the  influence  of  a  new  depress- 
ing agent  such  as  the  syphilitic  poison;  and,  in  fact, 
they  very  often  do  so,  but  not  necessarily. 

I  have  seen  scrofulous,  tubercular,  cachetic, 
rheumatic,  and  malarial  patients,  have  syphilis  in  an 
exceptionally  mild  manner;  and,  on  the  other  hand,  I 
have  seen  most  severe  syphilitic  manifestations  occur 
in  individuals  possessing  otherwise  the  most  brilliant 
health. 

That  there  is  something  special  and  peculiar  in 
the  physical  state  of  the  individual,  which  allows  him 
to  show  up  badly  under  the  overshadowing  influence 
of  the  syphilitic  poison,  I  believe  capable  of  demon- 
stration by  recalling  two  sets  of  facts.  In  the  first 
place,  I  have  on  several  occasions  treated  two  or 
three  men,  members  of  the  same  family,  and  possess- 
ing the  same  physical  traits,  diathetic  peculiarities, 


lO 


and  general  constitutions,  who  have  acquired  their 
syphilis  from  different  quarters  and  at  different  times 
of  life  respectively,  and  I  have  noticed  that  the  type 
of  disease  in  these  cases  was  quite  uniform,  in  the 
various  instances  which  have  come  within  my  range 
of  observation. 

A  second  and  still  stronger  well-known  fact,  bear- 
ing upon  the  point  now  under  consideration,  is  this: 
Children,  it  is  well  known,  have  stronger  constitutions, 
and  are  physicially  in  better  general  condition  than 
adults;  yet  the  physical  soil  of  childhood  seems  to  be 
the  best  for  syphilis  to  develop  upon,  and  the  disease 
acquired  in  childhood  is  much  more  often  fatal  than 
when  it  has  been  taken  on  at  any  later  period  of  life. 
No  demonstration  of  this  can  be  more  convincing  than 
the  various  epidemics  of  vaccinal  syphilis  which  have 
been  recorded  from  time  to  time.  The  mortality,  in 
these  instances,  is  tremendous,  and  it  seems  to  bear 
no  relation  to  the  country,  or  section,  or  district  in 
which  the  epidemic  of  vaccinal  syphilis  occurs,  and  to 
have  no  close  relation  to  the  diathetic  or  constitutional 
status  of  the  infants  vaccinated. 

In  one  respect,  however,  there  seems  to  be  a  dif- 
ference in  the  virulence,  the  actual  virulence,  of  the 
syphilitic  poison,  namely,  in  its  perpetuation  upon 
members  of  the  same  national  family.  The  syphilitic 
poison,  in  other  words,  seems  to  become,  finally,  ac- 
clamatized  in  a  given  country,  and  to  become  less 
virulent  the  longer  it  lasts  in  that  country,   so  far  as 


—   II  — 

the  inhabitants  of  that  country  are  concerned,  but  not 
for  others. 

It  has  been  stated  that,  in  Portugal,  practically 
everybody  has  syphilis,  and  that  the  type  of  the  dis- 
ease there  is  exceedingly  mild.  It  is  well  known  also 
that  when  syphilis  has  been  carried  by  sailors  and 
planted  upon  an  island  where  the  disease  had  been 
hitherto  unknown,  that  the  virulence  of  the  type  of 
the  malady  becomes  intense  and  its  mortality  rela- 
tively very  high.  This,  in  a  measure,  accounts  for 
certain  facts  that  have  been  observed:  namely,  that 
sailors  suffer,  as  a  rule,  more  severely  from  syphilis 
than  other  individuals  in  the  same  community.  The 
reason  for  this  is  probably  to  be  found  in  the  fact  that 
they  pick  up  their  syphilis  in  foreign  ports,  and  ac- 
quire that  form  of  disease  which  has  not  been  ac- 
clamatized  to  their  particular  style  of  physical  consti- 
tution. 

In  this  way  it  may  be,  and,  doubtless  is,  some- 
times a  fact,  that  a  stranger  travelling  in  China,  in 
South  America,  in  Central  America,  or  elsewhere, 
and  getting  syphilis,  acquires  it  in  a  more  severe  form 
than  he  would  have  done  had  he  been  poisoned  by 
the  home  product  which  had  been  bred  in-and-in  upon 
constitutions  similar  in  peculiarities  to  his  own. 

Of  course  this  generalization  does  not  cover  all 
cases.  But  it  seems  to  me  to  fit  pretty  accurately  in 
many  instances  in  which  I  have  observed  exceptional 
results.     The  truth  is,  however,  it  seems  to  me,  that 


12 


no  syphilis  can  be  pronounced  to  be  either  mild  or 
virulent  until  it  has  developed  itself,  and  then  it  ac- 
centuates its  own  type  by  the  manifstation  of  its  own 
symptoms.  Yet  a  disease  apparently  mild  is  not  al- 
ways so,  and  may  in  revenge  make  up  for  its  mildness 
by  a  prolongation  of  its  moderate  symptoms  and  an 
obstinacy  in  their  appearance,  which  brings  despair 
both  to  the  patient  and  to  the  physician.  On  the 
other  hand,  a  seemingly  desperate  case,  a  virulent  one 
in  the  beginning  of  the  attack  may  make  up  for  its 
severity  by  disappearing  at  a  comparatively  early  date. 
These  irregularities  are  observed  sufficiently  often  to 
make  it  possible  to  signalize  the  fact. 

A  constitution  which  in  itself  may  not  be  favor- 
able for  the  development  of  severe  syphilis,  may  be 
made  so  by  irregularities  of  life,  excesses  of  any  kind, 
and  especially  by  drinking,  while  a  certain  influence 
cannot  be  denied  to  the  patient's  constitutional  dia- 
thesis. This  drinking  and  irregularity  of  life  is  an- 
other reason,  probably,  why  sailors  often  have  more 
intense  late  symptoms  than  the  generality  of  man- 
kind. 

The  moral  is  that  when  a  patient  has  syphilis  he 
should  keep  himself  constantly  in  mind,  and  lead  a 
regular,  sober,  and  God-fearing  life.  In  this  way  he 
stands  the  best  chance  of  getting  only  what  he  is  en- 
titled to,  which,  considering  the  uncertainty  of  the 
disease,  ought  to  be  all  he  is  willing  to  endure. 


FALLACY  NO.   IN. 

A  local  sore  appearing  upon  the  penis  after  sexual  exposure 
necessarily  means  that  a  poisoning  of  some  sort  has  been 
encountered,  while  a  recurrence  of  sores  upon  the  penis 
without  further  exposure  is  proof  postive  of  spyhilis. 

This  idea,  of  course,  torments  only  the  ignorant — 
the  medically  ignorant;  but  the  number  is  great  in  the 
community  of  those  who,  being  over-solicitous  about 
themselves  on  account  of  the  consciousness  of  morbid 
dread  of  the  expected  horrors  of  syphilis,  regard  a 
little  discoloration,  a  pimple,  a  vesicle,  above  all  a 
pustule,  upon  the  penis,  with  more  alarm  than  they 
would  view  a  carbuncle  upon  any  other  portion  of  the 
body. 

•  This  dread  is  made  use  of  by  the  unscrupulous 
physician  who  doses  (with  or  without  mercury,  as  the 
case  may  be)  his  anxious  victim  for  a  certain  time 
after  each  abrasion,  or  each  attack  of  herpes,  and  then 
congratulates  him  upon  the  success  of  treatment  in 
preventing  the  disease  from  gaining  a  foothold  upon 
the  rest  of  the  body. 

The  bad  morality  of  this  course  is  no  worse  than 
the  folly  that  endorses  it,  for  sooner  or  later  a  true 
sore, — chancre  or  chancroid, — appears  and  then  the 
doctor  exposes  his  incapacity,  and  the  patient  seeks 
other  advice. 

The  truth  is,  as  any  observer  may  easily  convince 
himself,  that  vastly  the  greater  number  of  sores  as 


—   14  — 

found  at  random  upon  the  penis,  are  abrasions  and 
herpetic  outcrops — with  a  few  ordinary  pustules  and 
some  eczematous  spots, — and  that  these  are  in  no 
way  or  sense  contagious,  or  due  in  any  degree  to  a 
poison  in  the  party  of  the  second  part — although 
unmistakably  they  are  brought  out  by  friction  and 
local  irritation, — and  are  vastly  more  common  after 
sexual  contact  than  at  any  other  time. 

Then  again,  every  physician  has  seen  persistently 
recurring  attacks  of  herpes  progenitalis — in  both 
sexes, — coming  on  sometimes  after  every  sexual  act, 
at  other  times  relapsing  in  an  irregular  way,  at  dates 
having  nothing  to  do  with  sexual  contact  And  a 
curious  thing  about  these  attacks  is  a  fact  that  I  have 
often  verified  by  close  questioning,  namely,  this  re- 
lapsing herpes,. the  kind  that  comes  on  after  sexual 
contact,  the  kind  that  comes  on  after  contact  with  a 
strange  woman,  and  the  kind  that  relapses  spontane- 
ously at  irregular  intervals  without  having  any  imme- 
diate association  with  the  sexual  act;  all  these  varie- 
ties owe  their  first  origin  distinctly  to  a  given  chan- 
chroid,  to  a  badly  ulcerated  herpetic  cluster,  or  a 
severe  gonorrhoea. 

Before  the  occurrence  of  this  distinctly  marked 
primary  affection,  the  patient  has  been  locally  well; 
after  it  he  suffers  for  a  longer  or  shorter  period  from 
his  annoying  relapsing  malady. 

This  sequence,  of  course,  does  not  always  exist, 
but  it  is  common  enough  to  be  noticeable,  and,  I  be- 
lieve, must  be  recognized  as  a  fact. 


—  15  — 

Many  cases  of  relapsing  herpes,  on  the  other 
hand,  arise,  as  it  were,  spontaneously,  and  continue 
until  the  improved  health  of  the  patient  or  the  suc- 
cessful employment  of  remedial  means  has  effected  a 
cure. 

Relapsing  outcrops  of  ulcerative  trouble  under 
the  foreskin,  although  possible  in  the  course  of  syph- 
ilis (mucous  patches),  are  by  no  means  uncommon,  and 
their  occurrence  alone  is  no  indication  of  syphilis,  no 
matter  what  the  form  of  primary  irritation  which  may 
have  given  rise  to  the  recurrent  outbreaks. 

I  have  no  reason  to  believe,  from  personal  obser- 
vation, that  herpes  is  contagious,  or  that  its  advent 
can  be  ascribed  to  contact  with  any  especial  kind  of 
secretion,  or  any  virus.  It  does,  in  many  individuals, 
bear  a  direct  relation  to  the  sexual  act  — so  much  so 
that  I  have  more  than  once  heard  a  patient  excuse 
himself  for  not  noticing  and  attending  to  a  syphilitic 
chancre  on  the  ground  that  it  was  quite  a  common 
thing  for  him  to  have  herpes  after  sexual  intercourse, 
and  that  on  one  occasion  having  a  herpetic  ulcer  that 
remained  sore  longer  than  usual,  he  shortly  found 
himself  covered  by  an  eruptiou  which  his  physician 
pronounced  syphilitic. 


FALLACY  NO.  IV. 

Syphilis  is  at  first  a  local  disorder,  capable  of  modification  by 
local  treatment. 

This  fallacy  is  about  equally  spread  among  the 
public  and  with  physicians,  but  for  different  reasons. 
The  patient,  either  from  his  own  experience  or  from 
the  assurance  of  his  friends,  believes  that  a  local  sore 
upon  his  penis  may  be  destroyed  by  burning  or  other- 
wise, and,  in  that  manner,  that  he  may  escape  subse- 
quent disease.  This  belief  is  encouraged  by  the  cases 
of  individuals  who  have  been  alleged  to  have  syphilis 
by  their  physicians,  and  who,  after  local  treatment, 
have  suffered  no  further  discomfort.  The  truth  is, 
that  in  these  instances  the  physician  has  made  a  faulty 
diagnosis;  but  naturally  the  patient  knows  nothing  of 
this,  and  the  conclusion  as  he  draws  it  seems  to  him 
to  be  accurate. 

The  medical  profession,  on  the  other  hand,  enter- 
tain the  same  idea  on  account  of  the  encouragement 
which  has  been  given  to  this  notion  by  the  assertions  of 
German  physicians.  High  authorities  about  syphilitic 
matters  in  Germany  have  alleged,  and  still  allege, 
that  the  destruction  of  a  local  sore,  if  it  does  not  de- 
stroy the  actual  existence  of  syphilis,  at  least,  modifies 
the  subsequent  severity  of  symptoms. 

I  believe  that  this  assumption  is  entirely  false.  I 
have  myself  destroyed  a  number  of  chancres,  and 
have   treated   a   greater   number   of    patients   whose 


—  17  — 

chancres  had  been  excised  at  other  hands;  and  I  have 
no  reason  to  believe  that  the  subsequent  syphilis  has 
been  in  any  way  modified  by  this  primary  treatment. 
Burning  the  sore,  of  course,  is  not  now,  in  the  profes- 
sion, believed  to  have  any  controlling  effect  upon  the 
subsequent  development  of  symptoms,  and  I  believe 
that  those  who  advocate  the  excision  of  chancre  will 
eventually  retire,  from  their  position.  How  long  it  will 
take  to  educate  the  public  up  to  an  understanding  of 
the  fact,  that,  when  the  chancre  appears,  syphilis  is 
already  well  under  way,  I  do  not  know;  but  I  think 
that  the  sooner  this  undoubted  truth  is  recognized  the 
better  it  will  be  both  for  the  patient  and  for  the 
physician. 

A  belief  in  the  efficacy  of  the  excision  of  chancre 
has  still  a  hold  upon  the  profession  in  Germany,  and 
to  a  moderate  extent  in  France.  I  think  it  has  been 
practically  given  up  in  England  and  in  this  country. 
There  is  undoubtedly  no  objection  to  the  excision  of 
chancre.  The  wound  heals  quicker  than  the  chancre, 
and  a  focus  at  which  in  after  years  a  gumma  may  ap- 
pear, is  disposed  of,  but  to  tell  a  patient  that  cutting 
out  his  chancre  will  prevent  him  from  having  syphilis 
is  a  mistake. 

3  LL 


FALLACIES  NO.  V.  AND  VI. 

V.  Syphilis  is  acquired  only  during  sexual  contact  and  is  con- 

tagious only  through  the  chancre. 

VI.  A  person  with  syphilis  is  so  poisoned  that  he  may  com- 
municate the  malady  by  any  contact  of  his  body  with 
that  of  another. 

These  fallacies,  of  course,  app^ly  only  to  the 
public.  No  well-educated  physician  for  a  moment 
aquiesces  in  either  of  them.  Yet  they  are  constantly 
brought  to  his  notice,  and  some  intelligent  sugges- 
tions about  them,  to  the  patient,  are  often  necessary, 
in  order  to  shield  certain  members  of  the  community 
from  the  danger  in  which  they  exist  during  the  pres- 
ence of  syphilis  in  their  neighborhood. 

The  idea  that  syphilis  is  only  acquired  during 
sexual  contact,  absurd  as  it  is,  is  so  wide-spread  that 
many  patients  believe  that  a  knowledge  by  others  of 
the  existence  of  their  malady  carries  with  it  their  own 
disgrace.  Yet  all  teaching,  and  all  experience,  demon- 
strate that  no  shrine  of  virtue  is  sufficiently  im- 
pregnable to  be  able,  under  all  circumstances,  to  be 
free  from  the  possible  access  of  syphilis  in  some  of 
its  protean  forms,  and  a  person  in  absolute  innocence, 
one  who  has  never  had  sexual  contact  with  another, 
may  be  a  victim  of  the  disease,  as  well  as  the  most 
vicious  member  of  the  community. 

On  the  other  hand,  the  unnecessary  solicitude  of 
patients   about   syphilis,  regarding    its    contagion,  is 


—  19  — 

equally  unwarranted.  Many  a  man  feels  when  he 
has  the  disease  that  he  cannot  use  the  same  basin 
with  another,  or  the  same  towel,  or  the  same  bath- 
tub, and  that  he  must  keep  his  person  from  any  con- 
tact, either  by  shaking  hands  or  in  kissing,  with  those 
who  are  about  him,  and  who  naturally  expect  his 
caresses.  It  is  simply  necessary  in  cases  of  this  kind, 
to  impress  the  patient  with  the  fact  that  the  earlier 
manifestations  of  the  disease  alone  convey  the  poison 
through  their  secretion.  I  am  not  aware  that  it  has 
ever  been  proved  that  a  gummatous  ulcer  ever  com- 
municated the  disease  to  another. 

I  know  that  in  one  instance  it  has  been  alleged 
that  a  physician  acquired  syphilis  while  operating 
upon  a  gummatous  necrosis  of  the  forehead,  and  I 
know  of  another  surgeon  who  ascribes  his  syphilis  to 
a  poisoning  received  from  gummatous  disease  of  the 
anus— but  when  a  physician  claims  that  his  syphilis 
upon  the  finger  is  due  to  a  given  source,  it  must  be 
remembered  that  the  same  abraded  finger  has  been 
in  many  other  suspicious  neighborhoods  besides  the 
one  which  its  owner  recalls,  and  a  possibility  of  error 
is  consistent  with  the  most  absolute  honesty  of  con- 
viction. Indeed  it  seems  strange  to  me  that  all 
physicians  do  not  sooner  or  later  become  infected, 
since  they  are  proverbially  careless  in  their  habits, 
and  become  careless  of  a  danger  with  which  they  be- 
come familar  by  constant  contact.  Their  fingers  are 
as  subject  to  hang-nails,  and  more  liable  to  be  covered 


20 


by  cuts  and  abrasions,  than  those  of  the  rest  of  the 
community,  yet  their  profession  makes  it  necessary 
for  them  to  thrust  these  fingers  into  all  sorts  of  sus- 
picious and  foul  cavities,  and  to  manipulate  all  vari- 
eties of  contagious  sores. 

Among  the  early  lesions  of  syphilis,  also,  it  is 
wjpU  for  the  patient  to  know  that  only  those  yielding 
a  moist  discharge  are  capable  of  spreading  the  dis- 
ease, and  then  only  when  such  discharge  is  brought 
into  contact  with  an  abraded  surface  upon  the  person 
of  another. 

Kissing  is  perhaps  the  most  fruitful  source  of  the 
non-sexual  spread  of  syphilis  in  the  community,  and 
its  indulgence,  especially  in  any  excessive  or  pro- 
tracted manner  should  be  forbidden  to  patients  with 
mucous  patches  upon  the  tongue  or  lips. 

Yet  the  innocent  must  and  do  sometimes  suffer. 
I  remember  being  much  impressed  on  one  occasion 
by  the  following  circumstances: 

A  modest  young  girl  was  brought  to  the  hospital 
covered  with  a  syphilitic  roseola,  and  with  corrobora- 
tive symptoms  of  the  nature  of  which  there  could  be 
no  doubt.  Examination  proved  her  to  be  a  virgin, 
and  she  had  no  knowledge  of  any  primary  sore. 
Finally  a  small  livid  scar  was  found  upon  one  fore- 
arm, and  above  it  engorged,  indolent,  very  large  epi- 
trochlear  and  axillary  glands.  Upon  having  her 
attention  called  to  it,  the  girl  remembered  that  she 
had,  some  months  before,  scratched  this  spot  with  a 


21 


pin,  and  that  later  upon  the  scratched  area  a  sore 
had  appeared  which  had  been  very  slow  in  healing. 
It  turned  out  that  she  was  in  the  habit  of  taking  care 
of  a  baby,  as  nurse;  and  when  the  baby  was  sent  for 
and  examined,  its  anus  was  found  to  be  still  the  seat 
of  numerous  mucous  patches.  The  parents  were 
poor;  the  baby  did  not  wear  diapers,  and  the  nurse- 
girl  carried  it  upon  her  bare  arm  habitually.  The 
scratch  of  the  pin  was  the  missing  link. 

The  pearly  patches  of  changed  epithelium  found 
upon  the  tongue  very  late  in  syphilis,  do  not  convey 
the  poison.     They'  yield  no  secretion. 

The  dry,  scaling  patches  on  the  palm,  which 
so  often  persist  for  months,  even  years,  are  also,  in 
my  opinion,  free  from  the  imputation  of  possibly  con- 
veying the  disease. 


FALLACY  NO.  VII. 

Mercury  is  an  evil  only  less  serious  than  syphilis  itself,  and  to 
be  accepted  in  the  treatmetit  ot  syphilis  on  the  same 
ground  that  one  would  advocate  jumping  from  a  high 
window  in  order  to  escape  from  a  burning  building. 

This  fallacy  includes  in  its  ranks  of  adherents  all 
the  laity  and  a  greater  part  of  the  profession.  Its 
adherents  are  strengthened  in  their  belief  by  the 
opinions  of  many  regular  and  irregular  practitioners, 
and  especially  by  the  loud-mouthed  pretensions  of 
charlatans  who  preach,  publish,  and  pretend  to  prac- 
tice a  cure  of  syphilis  without  the  aid  of  that  so-called 
enemy  of  the  blood  and  bones— mercury. 

I  believe  this  general  impression  to  be  with- 
out any  foundation  in  fact — at  least,  relatively  so. 
Doubtless,  mercury  is  not  as  directly  useful  to  a 
patient's  blood  as  iron,  but  I  believe  it  to  be  as  harm- 
less as  quinine  if  used  in  a  proper  manner.  The  result 
of  my  investigations  upon  this  subject  need  not  be 
repeated  here.  They  are  accessible  to  all  who  desire 
to  look  into  them.  The  conclusions  I  have  reached 
were  arrived  at  during  my  study  of  the  effect  of  mer- 
cury upon  the  red  blood-corpuscles  in  the  treatment 
of  syphilis,  and  I  found,  while  following  up  that  sub- 
ject, that  in  conditions  of  health,  chronic  disease,  and 
syphilis,  alike,  the  continued  use  of  small  doses  of 
mercury  augmented  the  number  of  red  blood-cells, 
and  was  of  apparent  advantage  to  the  patient. 


—  ^z  — 

I  do  not  believe  this  advantage  great  enough  to 
justify  a  patient,  in  ordinary  conditions  of  health,  in 
resorting  to  mercury  as  a  tonic;  but  I  know  that 
many  of  the  best  physicians  in  New  York  city  pre- 
scribe small  doses  of  mercury  in  conditions  of  chronic 
disease,  not  syphilitic,  involving  the  lungs,  liver,  kid- 
neys, stomach,  and  blood. 

It  has  been  maintained  with  every  possible  show 
of  accuracy,  that  the  reason  the  red  blood  cells  are 
increased  under  a  mild  mercurial  course  is,  not  be- 
cause their  number  is  augmented,  but  because  their 
death  is  delayed;  and  it  is  by  arresting  the  metamor- 
phosis of  tissue  that  the  red  blood  corpuscles  are  re- 
latively increased  and  not  by  an  actual  tonic  influence 
of  the  drug.  This  is  very  likely  the  case  but  is  a 
matter  of  no  importance  relatively  to  the  effect  aimed 
at  by  the  physician,  and  I  think  it  need  not  be  to  the 
patient  in  consideration  of  the  great  benefit  to  be  ex- 
pected from  mercury  in  the  treatment  of  so  serious 
an  enemy  to  mankind  as  syphilis. 

And  even  if  it  were  a  fact  that  the  prolonged  use 

of  mercury  did  harm,  yet  time,  the  great  judge  of  all 

methods,  has  as  yet  failed  to  offer  any  other  remedy 

\      of  anything  like  comparable  value  in  the  treatment  of 

syphilis. 

The  alleged  bad  effects  of  the  drug  are  only 
found  after  its  excessive  use,  a  use  which  sound 
medical  judgment  does  not  justify.  Salivation  is 
rarely  ever  allowable  in  the  treatment,  and  the  general 


—    24    — 

opinion  of  most  authorities  in  all  parts  of  the  world 
is,  that  mild  mercurial  medication,  more  or  less  pro- 
longed, is  essential  to  the  correct  management  of  the 
disease. 

I  have  had  patients  continuously  upon  a  mer- 
curial course  for  three  and  a  half  years — and  for  all 
periods  of  less  length,  and  I  have  yet  to  see  a  case  in 
any  way,  either  as  to  his  bones,  his  nerves,  or  his 
digestion,  injured  by  its  use. 

As  for  the  immediate  effect  upon  the  patient's 
consciousness  of  well-being,  I  have  on  more  than  one 
occasion,  when  it  came  to  be  time  in  my  opinion  for 
the  continuous  mercurial  course  to  be  stopped,  had 
the  patient  seriously  ask  me  whether  it  would  hurt 
him  to  continue  the  course  indefinitely  on  the  ground 
that  he  had  never  felt  as  well  in  his  life  as  while  upon 
his  mild  mercurial  dose. 


FALLACY  NO.  VIII. 

Mercury  when  used  by  the    method   called  "the   tonic    treat- 
ment," effects  a  cure  by  virtue  of  its  tonic  action. 

I  feel  it  not  unjustifiable  to  give  this  statement  a 
position  among  the  fallacies  because  I  am  responsible 
for  the  name  ''  tonic  treatment,"  and  because  the 
view  obtains  generally  in  the  profession  that  I 
have  named  the  long-continued  use  of  mercury 
in  mild  doses,  "the  tonic  treatment  of  syphilis," 
because  I  believe  that  mercury,  so  used,  cures 
syphilis  by  virtue  of  some  tonic  action  possessed 
by  the  drug.  This  position  I  do  not,  and  have 
never  held.  I  do  believe  that  mercury  in  small 
doses,  continuously  given,  acts  practically  as  a  tonic, 
but  it  is  not  because  it  acts  as  a  tonic  that  it  is  useful 
in  syphilis,  when  administered  in  this  manner.  On 
the  contrary,  other  drugs  are  more  valuable  as  tonics; 
but  do  not,  by  virtue  of  their  tonic  action,  cure  the 
disease.  They  may  improve  the  patient's  condition 
but  the  disease  goes  on  in  its  manifestation  of  symp- 
toms uninterruptedly,  in  spite  of  the  tonic  action  of 
the  drug,  as  for  instance,  when  iron,  the  vegetable 
bitters,  mineral  acids,  etc.,  are  used.  I  only  claim, 
and  have  claimed,  that  mercury,  used  in  large  doses, 
in  an  attempt  to  abort  syphilis  or  to  crowd  out  the 
symptoms  by  its  specific  power,  while  it  effects  its  ob- 
ject upon  the  symptoms,  does  so  to  the  detriment  of 
the  patient,  and  deteriorates   his  blood,  being    in    no 


—    26    — 

wise  a  tonic  remedy.  I  claim  also  that  the  drug  may- 
be used  continuously,  in  small  doses,  so  as  to  elimin- 
ate the  disease  gradually,  and  to  keep  the  symptoms 
within  check,  and  perhaps  control  them  entirely,  in  a 
majority  of  the  cases,  as  they  are  ordinarily  en- 
countered, while  the  drug  continues  to  act  as  a  tonic 
by  increasing  the  number  of  red  cells  in  the  blood.  In 
this  way  it  is  not  because  it  is  a  tonic  that  it  is  useful 
in  syphilis,  but  because  it  is  a  specific;  yet  its  method 
of  use  is  such,  that  while  exerting  its  specific  action, 
it  still  acts  also  as  a  tonic,  much  to  the  advantage  of 
the  patient. 

Very  often,  while  used  in  its  tonic  form,  mercury 
fails  to  entirely  control  symptoms,  and  under  these 
circumstances,  it  is  of  coursedesirable,  even  necessary, 
to  increase  the  dose,  and  to  forego  for  a  time  the 
tonic  effect,  which  I  believe  should  be  generally  and 
continuously  aimed  at  during  the  entire  treatment  if 
the  patient  can  be  managed  and  kept  under  proper 
observation.  Mercury  is  a  tonic  in  small  doses,  and  in 
small  doses  always  moderates,  sometimes  controls,  the 
disease,  not  because  it  is  a  tonic  but  because  it  is  a 
specific,  and  the  specific  effect  persists  even  while  it 
is  used  in  such  a  way  as  to  be  also  a  tonic  in  its 
general  effect. 

It  seems  to  me  that  this  distinction  is  clear;  and 
I  cannot  understand  how  or  why,  if  it  is  a  fact,  any- 
one can  find  serious  objection  to  it.  That  it  is  a  fact, 
is  clear,  because  I   have  demonstrated  it,  and  that 


—    27    - 

demonstration  has  never  been  controverted.  When  it 
is  controverted,  it  will  be  time  enongh  to  deny  the 
fact. 

My  demonstration  consisted  in  proving  that  mer- 
cury used  continuously  for  periods  of  three  years  and 
more,  in  small  doses  (and  I  also  proved  the  small 
dose  to  be  one-half  the  quantity  that  in  a  given  case 
produced  irritative  or  medicinally  specific  effects — 
diarrhoea,  or  commencing  salivation) — that  mercury 
so  used,  not  only,  as  a  rule,  moderated  the  intensity 
of  the  syphilitic  symptoms  and  postponed  their  ap- 
pearance, more  or  less,  but  at  the  same  time  increased 
the  number  of  the  red  blood-cells  in  the  blood,  and 
maintained  them  at  a  relatively  high  average. 

A  continued  experience  with  the  same  method 
enables  me  now  to  assert  that  no  detriment  of  any 
kind  that  I  can  discover  in  prolonged  observation 
after  the  treatment  has  been  stopped,  attaches  to  the 
treatment — there  is  no  deleterious  after-effect,  no 
damage  inflicted  upon  the  patient. 

These  statements  I  believe  now  to  be  demon- 
strated facts — I  say  demonstrated,  because  no  one 
has  controverted  them,  and  they  have  been  before 
the  profession  since  1876. 

One  serious  effort  has  been  made  to  controvert 
the  statement  that  mercury  continuously  used  in 
small  doses  is  a  tonic.  A  gentleman  in  Germany, 
named  Schlessinger,  undertook  to  upset  the  theory  by 
a  protracted   set  of  experiments  upon  animals,  and 


—    28    — 

published  his  results  in  an  extended  thesis.  He 
found  that  the  long-continued  use  of  mercury  in  ani- 
mals did  increase  the  number  of  the  red  blood-cells 
and  maintained  a  high  average  of  the  same;  the  ex- 
ceptions, if  I  remember  rightly,  were  the  hen,  and,  I 
believe,  also  the  goat,  but  in  the  main  the  same  result 
obtained  in  animals  as  in  man.  Yet  his  dog,  which 
he  kept  caged  for  a  year,  grew  over-fat,  and  when  the 
mercury  was  suddenly  intermitted  and  he  was  turned 
out,  he  got  diarrhoea  and  rapidly  lost  flesh — an  occur- 
rence not  to  be  much  wondered  at,  on  account  of  his 
changed  conditions  as  to  exercise.  When  this  dog 
was  killed,  there  was  fat  between  the  muscular  fibres 
of  the  heart,  and  the  same  between  the  tubules  in  the 
kidney,  while  there  was  an  atheromatous  patch  upon 
the  aorta. 

The  temperature  also  was  not  changed  (as  after 
the  use  of  iron  as  a  tonic),  and  the  excretion  of  urea 
was  diminished — hence  Schlesinger  concluded  that 
(i)  mercury  is  not  a  tonic— (because  it  does  not  work 
in  the  same  way  as  iron  and  other  tonics),  and  (2) 
that  it  tends  to  produce  accumulations  of  fat,  and  to 
lead  to  degenerative  processes,  and  that  the  increase 
in  the  number  of  blood-cells,  which  is  most  obvious, 
is  due  not  to  an  acutal  increase  in  their  number,  but 
to  an  arrest  in  their  death — they  live  longer  and  do 
more  work. 

Accepting  all  these  statements,  I  still  maintain 
that  mercury  is  essentially  a  tonic  for   all   practical 


\ 


—  29  — 

purposes.  I,  further,  do  not  believe  that  mercury, 
long-continued  in  small  doses,  produces  either  an  accu- 
mulation of  fat,  or  leads  to  fatty  degeneration,  much 
less  to  atheroma,  for  a  long  and  unbiased  observa- 
tion has  failed  to  disclose  these  things  to  me.  That  a 
healthy  dog  caged  for  a  year,  dosed  with  mercury  and 
deprived  of  his  exercise,  should  run  into  fatty  degen- 
eration, I  believe  to  be  quite  natural;  but  a  man  does 
not  copy  the  same  conditions,  and  practically  he  d5es 
not  grow  fat  under  the  prolonged  use  of  mild  doses 
of  mercury;  moreover,  the  dose  to  the  dog  may  have 
been  somewhat  excessive  for  him. 

It  is  idle  to  maintain  that  this  so-called  tonic 
treatment  is  the  only  correct  course.  I  do  not  so 
maintain,  but  I  do  hold  that  it  is  a  good  course,  that 
it  is  generally  efficient,  that  it  is  well  borne  as  a  rule, 
and  that  no  possible  injury  comes  of  its  use.  It  is  the 
best  course  I  know,  and  if  I  had  syphilis  myself  I 
would  prefer  it  to  any  that  I  know  or  have  ever  heard 
of. 

No  special  form  of  mercury  need  be  employed 
in  carrying  out  this  treatment — any  kind  of  mercurial 
preparation  that  can  be  taken  internahy  may  be  used. 

Here,  again,  I  have  been  judged  by  the  profes- 
sion, and  my  generalizations  narrowed  down  to  very 
small  limits.  I  am  constantly  confronted  with  the 
statement  that  "  my  treatment  of  syphilis  is  by  the 
long-continued  use  of  the  protoiodide  of  mercury," 
This  is  not  a  fact.     I  use  also  grey  powder,  blue  pill, 


—  30  — 

corrosive  chloride,  calomel,  biniodide,  tannate  of 
mercury,  or  any  form — in  selected  cases. 

It  is  not  the  form  of  the  drug  upon  the  value  of 
which  I  insist,  but  rather  upon  the  form  of  the  course 
— continued  use  of  mild  tonic  doses. 

I  generally,  it  is  true,  use  the  granules  of  the 
protoiodide,  one  centigramme  each — and  I  use  those 
made  by  Garnier  and  Lamoureux,  sugar-coated,  be- 
cause I  find  them  reliable  and  generally  uniform. 
They  may  be  obtained  all  over  the  country,  and  are 
the  same  wherever  found.  They  do  not  change  in 
hot  climates.  They  do  not  stick  together.  I  have 
selected  them  on  account  of  these  qualities  and  for 
no  other  reason.  The  protoiodide  as  freshly  put  up 
by  the  apothecary  — the  green  iodide — varies  greatly 
as  found  in  one  shop  and  another.  It  is  unstable  and 
does  not  keep,  undergoing  changes  from  exposure  to 
light  and  heat,  and  from  simple  lapse  of  time.  So 
that  if  a  patient  is  taking  a  given  dose  of  protoiodide, 
made  up  in  New  York,  and  his  prescription  gives  out 
in  Chicago,  the  pills  he  receives  there,  if  freshly  made, 
are  liable  to  have  a  different  effect  from  those  he  has 
been  taking. 

On  this  account,  and  on  this  account  only,  it  is 
de&irable  to  have  a  uniform  and  unchangeable  pre- 
paration that  will  be  found  of  about  uniform  quality 
everywhere. 

Finally  several  manufacturing  pharmacists  have 
come  to  me  with  a  beautiful  yellow  iodide  of  mercury, 


—  31  — 

and  have  convinced  me  that  this  is  the  chemically- 
pure  protoiodide  while  the  green  iodide  owes  its  color 
to  impurities.  On  this  account  I  have  been  asked  to 
adopt  a  yellow  iodide— but  why  ?  I  do  not  use  the 
green  iodide  because  it  is  green,  I  do  not  care 
whether  it  is  pure  or  not.  I  use  it  because  it  is  uni- 
form (when  sugar-coated)  manageable  and  effective 
— and  I  see  no  reason  to  change  it  because  it  is  im- 
pure. Indeed,  I  know  that  the  French  granules  are 
very  impure.  Crack  a  granule  and  one  may  see  in- 
side the  sugar  coating  first  a  purple  layer— iodine 
liberated  under  the  sugar  coating — then  rub  down 
the  contents  and  use  a  strong  glass  and  there  will 
appear  metallic  globules  of  mercury  and  often  a  faint 
bright  red  line — the  biniodide— both  products  due  to 
a  partial' decomposition  of  the  green  iodide. 

I  know  therefore  that  the  granules  are  very  im- 
pure— but  I  use  them  because  they  seem  to  be  uni- 
formly impure,  and  because  their  effect  is  continu- 
ously reliable.  The  yellow  iodide  granules  I  tried 
patiently.  They  are  too  strong  for  general  use,  too 
irritating;  they,  too  closely,  resemble  biniodide  pre- 
parations in  their  general  effect.  Truly  they  might 
be  used  in  smaller — perhaps  milligramme  granules — 
but  still  their  general  irritative  quality  would  be  in 
my  opinion  unnecessarily  pronounced. 

I  do  use  the  yellow  granules  in  selected  cases, 
notably  when  constipation  is  a  natural  tendency;  for 
then    sometimes   the    green   iodide  granules  do   not 


—  32  — 

carry  themselves  off  and  too  great  a  mercurial  effect 
is  induced. 

This  brings  me  to  state  why  I  select  the  green 
iodide  at  all,  as  a  proper  drug  with  which  in  most 
cases  to  follow  out  the  tonic  treatment  of  syphilis. 
It  is  not  because  generally  speaking  I  consider  it  the 
best  mercurial  preparation,  but  because  I  consider  it 
medicinally  speaking  the  very  worst — possibly  not 
the  very  worst,  because  the  red  (biniodide)  and  the 
yellow  (pure  protoiodide)  are  still  worse, — medicin- 
ally speaking. 

Most  of  the  other  mercurials  are  better,  the  blue 
pill  is  more  bland,  the  grey  powder  milder,  the  bichlor- 
ide far  more  prompt,  more  effective,  and  in  minute 
doses  I  believe  more  actively  tonic;  but  these  drugs  are 
like  a  two-edged  sword,  potent  for  harm  as  well  as  for 
good.  It  must  be  remembered  that  the  tonic  treat- 
ment of  syphilis  puts  the  responsibility  very  greatly  in 
the  patient's  hands.  It  does  away  a  good  deal  with 
the  old  pottering  method,  which  compels  the  patient 
to  show  up  every  few  days  and  have  his  prescription 
changed.  The  patient  knows  what  he  is  taking,  and 
why  he  is  taking  it;  and  he  may  go  off  for  a  month  or 
longer  after  his  **  tonic  dose  "  is  regulated,  and  only 
need  show  up  when  something  new  appears. 

The  mild  and  the  bland,  and  the  sharply  efficient 
mercurials  are  not  usually  as  trustworthy  in  such  a 
course.  Their  influence  is  too  insidious,  and  with 
their   use   the    patient   may  be  on    the  verge  of,   or 


—  33  — 

actually   in    a   state    of,    salivation    before    he    fairly 
knows  it. 

This  is  not  likely  to  occur  if  he  uses  the  proto- 
iodide.  This  drug  is  irritating.  It  irritates  the  in- 
testinal tract.  If  a  patient  from  some  change  of  con- 
dition, some  irregularity  of  diet,  some  excess  of  acids 
ingested,  some  cumulative  effect  of  the  drugs,  is  in 
danger  of  getting  beyond  the  tonic  influence,  the  pro- 
toiodide  generally  gives  him  the  most  efficient  warn- 
ing in  the  shape  of  griping  pains  and  loose  diarrhoeal 
movements;  and,  though  a  fool,  he  can  appreciate 
this,  and  stop  his  medicine  until  his  digestive  com- 
motion is  over.  Not  so,  perhaps,  if  he  were  taking 
one  of  the  more  bland  and  efficient  forms  of  mercury. 
They  might  get  him  beyond  his  tonic  influence  and 
into  trouble  without  proper  warning. 

This  bad  quality  of  the  protoiodide,  therefore,  is 
its  safety.  The  quality  is  possessed  even  in  a  greater 
degree  by  the  yellow  and  the  red  iodides,  but  here 
the  irritative  quality  is  too  great,  and  the  drugs  not 
suitable  for  very  general  use. 

Sometimes  even  the  green  iodide  is  too  irritating 
to  be  used.  I  have  encountered  patients  more  than 
once  who  could  not  take  even  one  centigramme  a 
day  of  the  green  iodide  without  having  immediate  in- 
testinal pain  and  diarrhoea.  In  such  cases,  manifestly, 
the  protoiodide  is  not  a  proper  drug  to  use,  and  some 
other  form  of  micrcurial  has  to  be  selected. 

I  hope  I  have  made  these  points  clear,     (i)   In 


4    LL 


—  34  — 

my  opinion  the  tonic  treatment  of  syphilis  is  not  cura- 
tive by  reason  of  the  tonic  dose  used,  and  (2)  the  pro- 
toiodide  is  the  best  drug  to  employ,  not  because  it  is 
any  more  tonic  or  any  more  curative  than  another, 
but  because  it  irritates  the  intestine  when  used  in  any 
excess,  and  therefore  is  safe  in  the  patient's  hands. 


FALLACY  NO.  IX. 

Mercury  cures  syphilis  ! 

This  is  and  is  not  a  fallacy,  yet  it  is  so  positively 
true  that  its  discussion  finds  a  natural  place  here. 
If  it  does  not  cure  syphilis  there  is  no  other  drug  that 
will,  as  far  as  I  know,  and  the  fact  that  it  has  stood 
the  test  of  centuries  of  use  and  abuse,  that  it  has  out- 
lived strong  popular  prejudice,  that  it  is  to-day  the 
most  universally  employed  of  all  drugs  in  the  man- 
agement of  the  disea'Se,  goes  largely  to  prove  that  in 
the  minds  both  of  patients  and  the  profession  it  is 
curative. 

Furthermore  it  is  resorted  to  by  those  who  be- 
lieve that  its  effect  is  pernicious  when  they  have  to 
do  with  cases  of  particularly  severe  type  which  do 
not  get  on  well  with  other  remedies.  Thus,  Diday,  of 
Lyons,  claims  that  the  type  of  syphilis,  as  he  en- 
counters it,  is  mild,  and  that  mercury  is  not  required 
in  its  treatment  yet  in  all  severer  cases  he  uses  the 
drug.  So  also  Boeck,  of  Christinia,  that  honest  and 
gentle  apostle  of  syphilization,  told  me  when  he  was 
in  New  York,  that  when  syphilization  failed  to  con- 
trol symptoms,  he  also  after  a  time  had  recourse  to 
the  ordinary  drugs  — notably,  however,  to  the  iodide 
of  potassium  in  the  case  of  gummata— which  latter 
he  claimed  were  rarely,  although  occasionally,  en- 
countered after  treatment  by  syphilization. 


-36- 

This  fact,  by  the  way,  the  occurrence  of  gum- 
mata  after  non-mercuric  treatment,  ought  to  weigh 
largely  in  proof  of  the  lack  of  connection  between 
the  early  use  of  mercury  and  the  subsequent  develop- 
ment of  tertiary  lesions — a  connection  which  has 
been  asserted  to  exist  by  all  anti-mercurialists. 

But  to  return  to  the  subject  in  hand:  Does  mer- 
cury cure  syphilis  ?  Perhaps  not.  It  surely  causes 
the  symptoms  to  disappear,  but  then,  as  a  rule,  they 
continue  to  reappear  during  a  certain  rather  long 
period,  and  finally  in  a  majority  of  instances  they 
cease  to  reappear.  Is  it  then  the  mercury  that  cures 
the  disease  or  is  it  Time,  and  does  the  disease  only 
really  cease  after  the  individual  has  exhausted  his 
capacity  to  produce  symptoms.  Certainly  mercury 
does  not  cure  the  disease  actually,  nor  does  it  in  my 
opinion  materially  shorten  its  natural  period  of  ex- 
istence. It  is  not  uncommon  to  read  in  connection 
with  this  or  that  method  of  using  mercury  in  the  report 
of  a  case — so  many  inunctions,  so  many  injections, 
so  many  perigrinations  or  what  not,  and  a  remark  that 
the  patient  is  discharged  cured — that  he  returned  with 
what  is  called  a  relapse  later.  Surely  this  is  no  cure. 
When  a  patient  with  tertian  ague  has  a  good  day  he 
is  not  well.  To  be  well  he  must  go  over  in  safety 
not  only  a  day  upon  which  a  paroxysm  was  due  but 
often  a  seventh  day  and  sometimes  a  twenty-first  day, 
before  the  prudent  physician  pronounces  him  well. 

'On  the  other  hand  very  many  patients  go  through 


—  37  — 
all  their  syphilitic  manifestations  without  ever  taking 
mercury  and  at  last  they  get  well— at  least  symptoms 
cease  to  appear,  they  remain  for  long  periods,  per- 
haps indefinitely,  free  from  evidences  of  disease,  and 
finally  die  of  something  having  no  connection  with 
the  original  disorder. 

Therefore,  perhaps  it  is  Time,  and  Time  only,  that 
cures  syphilis;  but  still  this  is  no  reason  why  mercury 
should  not  be  used,  since  its  power  over  symptoms  is 
well  known,  and  since  ample  testimony  asserts  that  it 
does  no  harm.  Measles  and  scarlet  fever  run  their 
course;  medicine's  certainly  do  not  cure  them,  but 
this  is  no  reason  why  means  that  comfort  the  patient 
and  moderate  the  intensity  of  symptoms  should  not 
be  employed. 

Yet  the  question  is:  Does  not  mercury  do  more 
than  simply  moderate  or  control  symptoms  ?  Does  it 
not  help  to  cure  the  disease  itself  by  actually  antago- 
nizing and  gradually  overcoming  the  poison  ?  I  per- 
sonally believe  that  it  does  this.  I  believe  that  it  not 
only  controls  and  abolishes  symptoms,  but  that  its 
continued  use  renders  the  next  coming  out-crop  less 
intense,  and  that  it  postpones  its  appearance  to  a 
period  later  than  that  at  which  it  would  have  shown 
up  had  no  mercury  been  used — therefore  it  saves 
tissue,  prevents  scarring,  and  shields  the  functional 
activity  of  organs  whose  quality  would  have  been 
deteriorated  had  the  full  force  of  a  given  syphilitic 
lesion   been   allowed  to  expend   itself  upon   them— a 


_  38  - 

force  that  is  restrained  and  moderated  by  the  action 
of  mercury. 

I  believe  also  that  tertiary  symptoms,  though  by 
no  means  prevented  by  the  use  of  mercury,  are  cer- 
tainly less  common  in  patients  who  have  taken  a  pro- 
longed and  effective  mercurial  course — other  things 
being  equal — than  in  others  who  have  not  had  the 
benefit  of  such  a  course. 

I  base  this  assertion  upon  a  reasonably  long  per- 
sonal observation.  My  own  professional  life  is  only 
twenty-four  years,  but  during  sixteen  of  these  years  I 
was  constantly  associated  with  Dr.  Van  Buren,  and 
constantly  seeing  patients  that  had  been  treated  mer- 
curially  by  him  for  syphilis  at  varying  dates  pre- 
viously. His  case  books,  now  in  my  possession,  com- 
menced in  1847,  therefore  the  scope  of  my  observation 
is  practically  forty-three  years.  Dr.  Van  Buren,  as  is 
well  known,  was  largely  interested  in  venereal  and 
genito-urinary  work  during  his  entire  professional 
life,  and  the  number  of  his  cases  was  very  consider- 
able; yet  an  immense  majority  of  the  cases  treated 
mercurially  for  long  periods  during  their  earlier  years, 
have  entirely  escaped  tertiary  manifestations.  Ex- 
actly what  the  percentage  is  I  cannot  say,  but  I  know 
that  the  number  is  relatively  very  small,  and  that  the 
severe  cases  of  late  disease  that  I  have  encountered 
have  come  from  outside  sources. 

Undoubtedly  a  certain  number  of  cases  do  suffer 
severely  in  the  late  period,  in  spite  of  any  variety  of 


—  39  — 

earlier  treatment,  but  less,  I  believe,  relatively,  are 
supplied  out  of  the  number  of  those  who  have  under- 
gone efficient  and  prolonged  mercurialization  during 
their  earlier  years  of  disease,  than  from  the  other 
number  treated  by  other  methods  or  by  irregular  and 
excessive  mercurial  courses. 

On  a  question  of  this  sort,  perhaps  some  further 
testimony  is  needed  to  be  convincing,  outside  of  my 
personal  impression  and  statement.  Without,  there- 
fore, going  learnedly  into  authorities,  which  a  running 
commentary  of  this  sort  does  not  justify,  I  think  I 
can  sum  up  a  little  quite  recent  evidence  very  properly 
by  giving  the  views  of  some  well  known  gentlemen  as 
expressed  in  the  discussion  on  tertiary  syphilis  in  the 
International  Medical  Congress  of  Dermatology  and 
Syphilography,  at  Paris  in  the  summer  of  1889. 

The  discussion  turned  mainly  on  the  relative  fre- 
quency of  tertiary  syphilis,  and  the  conditions  that 
favored  its  development. 

Dr.  Newmann,  of  Vienna,  believed  that  the  con- 
dition which  most  prominently  favored  the  appear- 
ance of  late  lesions  was  a  neglect  of  early  mercurial 
treatment.  He  granted,  as  all  must  do,  that  certain 
cases  which  had  been  allowed  to  go  untreated,  yet 
escaped  tertiary  disease,  but  he  believed  such  cases 
to  be  exceptional,  and  he  believed  also  that  many 
other  cases  suffered  from  tertiary  symptoms  because 
their  mercurial  course  had  not  been  sufficiently  active 
and  not  sufficiently  prolonged.  • 


—  40  — 

He  mentioned  also  as  factors  in  the  causation  of 
tertiary  phenomena,  tuberculosis,  malaria,  diabetes, 
old  age,  alcoholism,  unhygienic  surroundings,  any- 
thing that  tends  to  weaken  the  organism  and  lessen 
its  power  of  resisting  disease. 

He  did  not  think  that  tertiary  symptoms  bore 
any  relation  to  the  virulence  of  the  original  sore  or 
the  violence  of  the  secondary  manifestations. 

Dr.  Fournier,  of  Paris,  who  is  always  statistical, 
presented  an  analysis  of  the  2,595  cases  which  he  had 
observed  in  his  own  practice.  According  to  these  he 
believes  that  tertiary  phenomena  appear  most  fre- 
quently from  the  first  to  the  third  year  after  infection 
— especially  in  the  the  third  year — decreasing  gradu- 
ally from  the  fourth  to  the  twentieth  year,  being  quite 
infrequent  between  the  twentieth  and  the  thirtieth 
years,  it  being  phenomenal  for  tertiary  syphilis  to 
appear  for  the  first  time  after  the  thirtieth  year, 
although  it  is  possible.  In  the  first  year  also,  the 
number  is  small,  but  he  had  seen  the  exceptionally 
large  number  of  129  cases,  in  which  the  tertiary  mani- 
festations appeared  during  the  first  year.  Among  his 
cases,  1,085  involved  the  nervous  system — or  exclud- 
ing locomotor  ataxia  68t. 

These  statistics  are  given  for  their  general  in- 
terest— not  because  they  bear  directly  upon  the  ques- 
tion under  discussion. 

Dr.  Vajda,  of  Vienna,  presented  the  statistics  of 
the  hospital  admissions  of  tertiary  syphilitic  patients 


—  41   — 

in  Vienna,  for  the  years  1870-77 — 632  cases  and  of 
these  62  per  cent,  had  not  had  any  previous  treat- 
ment at  all. 

The  average  date  of  appearance  of  the  tertiary 
symptoms  had  been  in  cases  not  treated,  three  years 
and  seven  months;  in  cases  which  had  been  treated 
during  the  early  stages,  six  years  and  four  months. 
How  efficient  or  prolonged  this  early  treatment  was 
he  does  not  state. 

Dr.  Haslund,  of  Copenhagen,  gave  the  statistics 
of  600  cases  which  he  had  encountered  m  his  own 
practice.  Of  these  444  (74  per  cent.)  had  not  been 
treated  previously  at  all,  or  had  been  inefficiently 
treated.  He  believes  that  alcohol,  excesses,  and 
chronic  malaria  are  important  co-operators  in  the 
production  of  tertiary  symptoms  and  that  the  reason 
for  the  allegation  that  tertiary  complications  are 
especially  common  after  extra-genital  chancre,  is  be- 
cause such  chancre  is  liable  to  be  overlooked  or 
ignored,  and  the  patient  therefore  less  likely  to  re- 
ceive efficient  constitutional  treatment.  He  believes 
also  that  cutaneous  tertiary  symptoms  are  the  most 
common,  next  those  of  the  nervous  system,  finally 
lesions  of  bone  and  the  internal  organs;  as  to  date  he 
expressed  a  belief  that  most  cases  of  tertiary  disease 
appeared  within  the  first  twelve  years  after   infection. 

Dr.  Mauriac,  of  Paris,  stated  that,  as  near  as  he 
could  estimate,  the  number  of  persons  who  suffered 
from   tertiary   manifestions   varied  between  five  and 


—  42  — 

fifteen  per  cent.,  taking  all  syphilitics  to  estimate 
from.  The  symptoms  most  commonly  come  on  be- 
tween the  third  and  sixth  year  — according  to  his 
observation. 

Finally,  Drysdale,  who  formerly  was  an  anti-mer- 
curialist,  stated  that,  in  his  belief,  the  proportion  of 
those  who  develop  tertiary  symptoms,  when  not 
treated  for  their  earlier  symptoms  by  mercury,  is 
about  eight  per  cent.  Since  he  had  returned  to  the 
use  of  mercury,  he  believed  that  he  could  assert  that 
its  use  had  power  m  averting  the  appearance  of  ter- 
tiary manifestations,  although  he  does  not  attempt  to 
express  it  by  giving  any  definite  figures. 

Thus  it  will  be  seen  that  an  array  of  very  repu- 
table testimony  from  Austria,  Denmark,  France,  and 
England,  is  in  accord  in  ascribing  to  mercury  a  defi- 
nite power  in  averting  the  appearance  of  tertiary 
syphilis — a  fact  that  ought  to  be  very  consoling  both 
to  those  who  administer  and  those  who  take  the  drug. 

This,  then,  seems  to  me  to  stand  as  a  proof  that 
mercury  has  curative  power  over  the  disease  itself — 
as  well  as  over  the  symptoms. 


FALLACY  NO.  X. 

The  iodides  are  less  harmful  than   mercury,   and  as  effective 
in  the  treatment  of  syphilis. 

This  statement  I  believe  to  be  clearly  a  fallacy. 
In  the  first  place,  I  believe,  and   I  think  I  have  de- 
monstrated, that  mercury  properly   used,  even  over  a 
period  of  many  years,  is  not   at  all  harmful,  and  that 
no  deleterious  immediate  or  after  effects  can  be  hon- 
estly ascribed  to  it.     When  mercury  is  used  as  it  is 
generally— in  fact  always  has  to  be  during  a  certain 
part  of  the  treatment,— in  its  specific,  and  not  in  its 
tonic   dose,    it    is   temporarily,  perhaps    permanently, 
harmful  if  the  specific  dose  is  carried  too  high  (saliva- 
tion) and  maintained  too  long.     But  here,  in  spite  of 
the  moderate  harmfulness  of  the  drug,  the  old  argu- 
ment holds,  and  its  employment  is  justifiable  because 
if  it  be  not  used  worse  harm  will  come  to  the  patient. 
Moreover,  no  judicious  practitioner   will  keep  up  the 
deleterious  specific  dose  any  longer  than  the  intensity 
of   the    symptoms  and    their   obstinacy    imperatively 
calls   for.      Practically   used   in   syphilis,   mercury  is 
effective  and  is  not  harmful. 

How  does  the  case  stand  with  the  iodides?  Their 
use  also  in  moderate  doses  is  tonic,  in  excessive  doses 
the  reverse.  They,  too,  cause  the  early  as  well  as  late 
symptoms  to  disappear.  They  are  indispensable  in 
attacking  gummata  and  in  many  conditions  of  the 
ulcerative  and  hyperplastic  order  occurring  early  in 


—  44  — 

the  disease  as  well  as  late — notably  some  of  the  earlier 
tonsillar  ulcerative  symptoms  accompanied  by  neigh- 
boring brawny  induration.  Why,  then,  are  not  the 
iodides  as  useful  in  the  treatment  of  syphilis  as  the 
mercurials,  and  at  least  as  little  harmful? 

In  answer,  I  state  it  as  my  belief,  that  the  iodides 
are  (i)  not  so  useful  in  opposmg  syphilis  as  mercury, 
(2)  more  likely  to  do  harm,  and,  finally,  (3)  that  it  is 
squandering  our  resources  to  appeal  to  iodides  for 
help  in  a  great  majority  of  cases  of  syphilis  during  the 
earlier  months— say  perhaps  the  first  year  of  the  dis- 
ease. 

I.  The  iodides  are  not  so  useful  in  opposing 
syphilis  as  the  mercurials.  This  is  evidenced  by  the 
greater  rapidity  with  which  the  symptoms  of  early 
syphilis  disappear  under  mercury  if  vigorously  given, 
as  in  the  mercurial  fumigation,  thorough  inunction; 
and  by  the  further  fact,  based  largely  upon  the  gen- 
eral consent  of  those  who  use  both  drugs,  that  while 
the  earlier  symptoms  undoubtedly  disappear,  and 
often  promptly  under  iodides,  yet  such  disappearance 
is  more  rapidly  followed  by  another  eruption  than 
when  mercury  is  used;  in  short,  mercury  not  only 
cures  the  early  symptoms,  but  it  postpones  the  ap- 
pearance of  the  next  succeeding  outbreak,  a  thing  to 
desired,  because  the  other  element  in  the  case  is  at 
work  night  and  day,  namely  Time. 

Furthermore,  the  patient's  morbid  sensitiveness 
during  the  early  months  of  syphilitic  outbreak  is  to 


—  45  — 
be  considered.  He  is  shy  of  each  pimple  more  or  less 
that  appears  upon  the  uncovered  parts,  therefore  it  is 
not  well  to  weight  him  with  the  pimples  of  acne  on 
the  face  which  are  so  liable  to  come  out  when  the 
iodide  is  first  used. 

Indeed,  this  is  one  of  the  tricks  of  charlatans. 
Many  and  many  a  frightened  patient,  free  from  all 
evidence  of  syphilis,  past  or  present,  has  consulted 
me  for  his  fancied  ill,  alleging  as  the  basis  of  his  be- 
lief in  his  own  syphilis  that  Dr.  So-and-so  treated 
him  for  a  sore  by  giving  him  medicine  which  "  drove 
the  disease  outin  pimples  on  his  face." 

2.  The  iodides  do  harm— that  is,  they  do  harm 
in  many  cases  if  used  in  large  doses  for  a  length  of 

time. 

To  be  consistent,  if  one  treats  syphilis  with 
iodides  from  the  start,  he  does  so  not  only  to  moder- 
ate symptoms,  but  with  the  express  intention  of  cur- 
ing disease.  Therefore,  the  patient  takes  his  drug 
more  or  less  largely  for  a  long  period  of  time.  Any 
alkaline  medication  long  persisted  in  is  liable  in  a 
certain  percentage  of  cases  both  to  upset  digestion 
and  to  thin  the  blood.  This  is  seen  in  those  who 
abuse  the  use  of  bicarbonate  of  soda,  and  the  same  is 
true,  although  to  a  less  extent,  of  the  iodide  of  po- 
tassium. 

Finally,  heavy  doses  of  the  iodide  long  continued 
are  capable  of  congesting  and  irritating  the  kidney, 
even   producing  transient    albuminuria  with   hyaline 


—  46  - 

casts.  This  I  have  more  than  once  seen,  and  noticed 
the  casts  and  albumen  disappear  with .  a  discontinu- 
ance of  the  drug. 

If,  therefore,  there  is  no  compensating  advan- 
tage, why  use  iodides  early  in  syphiHs  ?  They  have 
a  function  even  here,  but  it  is  for  certain  symptoms 
only,  and  then,  in  my  opinion,  only  for  intermittent 
use. 

3.  Using  iodides  in  early  syphilis  is  really 
squandering  our  resources  and  throwing  valuable 
material  to  waste.  It  is  something  like  the  faithful 
bear  who  kills  the  fiy  upon  his  sleeping  master's  brow 
with  a  rock.  It  may  kill  the  fly,  but  how  about  the 
master.  It  is  like  going  into  battle  and  employing 
all  the  reserve  forces  in  the  first  charge.  If  the  for- 
tunes ot  war  are  against  one,  he  finds  his  resources 
crippled  or  exhausted. 

It  is  against  the  more  serious  possible  ravages  of 
the  late  symptoms  that  we  should  hold  the  iodides  in 
reserve.  There  they  have  to  be  used  without  stint  to 
save  tissue  and  function,  and  it  seems  like  folly  even 
for  those  who  admit  the  greater  efficacy  of  the  iodides 
to  send  a  man  to  do  a  boy's  work. 

Finally,  many  patients  become  habituated  to  the 
use  of  a  given  drug,  so  that  if  it  is  employed  for  a 
time,  a  greater  quantity  must  be  employed  later  to 
produce  a  given  amount  of  effect  than  would  other- 
wise have  been  required.  This  alone  is  a  sufficient 
reason  for  not  using  the  iodides  early  in  syphilis,   for 


—  47  — 

it  should  be  our  effort  not  to  make  the  patient  take 
all  the  medicine  he  will  stand,  but  rather  to  manage 
his  symptoms  with  the  least  amount  of  drugging  pos- 
sible consistently  with  his  safety  and  general  advan- 
vantage. 


FALLACY  NO.  XI. 

The  treatment  of  syphilis  consists  only  in  the  use  of  mercury 
and  the  iodides. 

This  notion  has  its  stronghold  among  the  younger 
members  of  the  profession,  and  the  inexperienced. 
Every  graduate  from  a  medical  school  thinks  himself 
fully  competent  to  manage  syphilis.  All  he  has  to 
do  is  to  make  a  diagnosis,  and  then  give  mercury  for 
secondaries,  and  potash  (as  he  terms  it)  for  tertiaries, 
and  he  is  sure  to  succeed. 

This  is  very  far  from  being  the  case.  Outside  of 
the  intricacies  of  diagnosis  in  many  conditions  of  ob- 
scure syphilis,  tact  and  judgment  are  all — essential  to 
the  proper  management  of  this  protean  and  persistent 
malady.  Were  it  not  so,  patients  would  do  as  well  in 
the  hands  of  one  honest  practitioner,  as  in  those  of 
another,  which  is  obviously  not  the  fact. 

All  attention  must  be  paid  to  the  various  sur- 
rounding internal  and  external  modifying  influences, 
which  are  more  or  less  constantly  at  hand,  if  the  pa- 
tient's loyalty  to  treatment  is  to  be  maintained,  and 
his  course  to  be  made  as  smooth  as  possible  under 
the  circumstonces.  In  each  case  the  patient  must  be 
studied  and  treated  as  well  as  the  disease.  Diathetic 
influences  have  to  be  considered,  the  patient's  habits, 
his  hygienic  surroundings,  the  state  of  his  blood,  his 
greater  or  less  anaemia,  the  condition  of  his  digestive 


—  49  — 

machinery,  his  capacity  for,  and  tolerance  of,  drugs  in 
one  form  or  another. 

Many  a  patient  will  fail  to  get  well  upon  mercury 
or  the  iodides  given  in  one  form,  or  by  one  method, 
when  a  change  in  that  form  or  in  the  method  of  ad- 
ministration will  promptly  yield  a  brilliant  result. 

I  have  seen  patients  absolutely  refuse  to  improve 
under  the  internal  use  of  mercury,  and  promptly 
change  for  the  better  when  inunction,  fumigation,  or 
hypodermic  medication  was  resorted  to. 

I  have  seen  patients  grow  worse  under  iodide  of 
potassium,  and  improve  when  the  sodium  salt  was 
substituted — or  fail  to  respond  to  the  iodides  as  ordi- 
narily given,  and  yet  to  be  able  to  take  it  effectively 
in  milk  or  carbonated  alkaline  water.  I  have  fre- 
quently seen  a  stomach  intolerant  of  an  effective  dose 
of  iodide,  take  the  same  dose  and  a  larger  one  with- 
out complaint  after  a  change  of  food,  or  a  change  of 
air. 

In  the  common  straightforward  case,  often  the 
routine  use  of  mercury  and  iodides  is  practically  all 
that  is  called  for;  but  in  others,  all  of  ones  therapeutic 
and  dietetic  resources  are  taxed  in  order  to  accom- 
modate the  organism  to  the  necessary  medication. 

No  care  and  attention  is  thrown  away  in  this 
study,  and  to  be  most  effective  the  physician  should 
be  the  friend  and  counsellor  of  the  patient  as  well  as 
his  doctor. 

5  LL 


FALLACY  NO.  XM. 

Syphilis  in  the  parent  often  shows  itself  as  scrofula  in  the  chil- 
dren. 

This,  in  my  opinion,  is  altogether  a  mistaken 
notion.  Syphilis  in  the  parent,  if  transmitted  at  all, 
is  handed  down  as  syphilis,  and  as  nothing  else. 

The  whole  question  of  the  transmission  of  syph- 
ilis by  inheritence  is  still  sub  judice.  If  the  mother  is 
in  a  condition  of  acute  syphilis,  all  observers  are  in 
accord  that  the  child  is  also  syphilitic.  The  mother 
very  often  first  aborts,  perhaps  several  times  succes- 
sively, then  is  delivered  of  a  dead  child,  then  of  a 
child  apparently  healthy,  which,  after  a  few  weeks, 
shows  up  its  syphilis  by  snuffles  and  a  variety  of 
eruptions;  gets  jaundiced,  has  an  aged  aspect,  and  a 
cracked  quality  in  its  vocal  sounds,  and  shortly  dies — 
very  likely  in  convulsions.  The  next  following  child 
dies  also,  at  some  later  period  of  its  existence.  Finally, 
a  child  is  born  apparently  healthy,  but  it  has  bone 
disease,  probably  rickets,  grows  up  with  notched  cen- 
tral incisor  teeth  in  the  upper  jaw,  has  the  syphilitic 
countenance,  and  later  interstitial  keratitis  with  some 
ulcers  in  its  mouth,  and  perhaps  gets  gummatous 
disease  of  the  bones  of  the  nose  during  adolescence, 
deafness,  or  some  more  serious  expression  of  tertiary 
syphilitic  disease,  which  may  or  may  not  terminate 
its  existence. 

But  all  this  is  syphilis,  and  not  scrofula.     The 


—  51  — 

symptoms  when  they  yield  at  all,  do  so  to  the  same 
treatment  that  controls  syphilitic  manifestations  in 
the  adult. 

Finally,  such  a  mother  may  have  a  perfectly 
healthy  child,  which  may  grow  up  without  ever  show- 
ing any  indication  of  the  possession  of  the  syphilitic 
taint  in  any  of  its  various  forms. 

When  the  father  is  syphilitic,  and  the  mother  un- 
contaminated,  the  question  is  still  open  and  under 
warm  discussion  as  to  what  happens. 

The  leading  view  taken  by  a  majority  in  the 
profession  is  that  such  a  child,  while  it  may  be 
healthy,  is  quite  likely  to  be  diseased— in  a  syphilitic 
way;  yet  there  is  a  large  and  reputable  minority  in 
the  profession  which  maintains  that  syphilis  in  the 
father  is  not  transmitted  to  the  child  under  any  cir- 
cumstances, unless  the  mother  is  also  syphilitic. 

I  shall  not  attempt  to  give  the  two  sides  of  this 
argument  here.  There  is  much  to  be  said  on  both 
sides,  but  this  is  not  the  place  for  it.  Certain  it  is, 
that  the  child  of  a  syphilitic  father,  who  marries  five 
years  after  chancre,  having  himself  had  a  thorough 
and  prolonged  mercurial  treatment,  and  the  mother 
being  healthy,  certain  it  is,  according  to  my  experi- 
ence, that  the  children  of  such  a  union  remain  per- 
fectly healthy  so  far  as  syphilis  is  concerned.  I  have 
yet  to  see  in  my  own  practice  a  single  instance  to  the 
contrary. 

My  belief  is,  this  rule  is  invariable.    Many  sources 


—  52  — 

of  possible  error  exist  in  studying  this  question.  I 
cannot  go  into  the  matter  fully  here,  but  I  will  simply 
state  that  the  past  history  of  a  woman  is  much  more 
difficult  to  get  at  than  it  is  in  the  other  sex,  and  that 
women,  from  ignorance  or  a  more  subtle  motive,  may 
make  it  impossible  for  the  truth  to  be  arrived  at 
under  any  system  of  examination  or  cross-question- 
ing. 

I  will  give  two  personal  instances  in  point  which 
to  me  are  full  of  interest. 

A  young  gentleman,  many  years  ago,  came  to  me 
with  chancre,  and  asked  me  to  examine  for  him  a 
young  and  beautiful  lady,  the  daughter  of  a  distin- 
guished citizen,  who  in  the  folly  of  youth  had  yielded 
her  person  to  his  embraces. 

The  lady  had  a  chancre.  I  treated  her  continu- 
ously with  mercury  during  about  three  years.  Her 
secret  was  religiously  kept.  She  moved  in  the  best 
circles  of  polite  society.  Her  elegance,  her  dress, 
and  her  beauty  found  their  way  into  print  m  the 
fashion  items  of  the  daily  press.  Her  symptoms, 
fortunately  mild,  but  distinctive  when  they  did  occur, 
never  attracted  attention  in  her  own  family  circle, 
and  she  passed  through  her  entire  course  of  treat- 
ment without  ever  exciting  the  suspicion  of  any  one. 
She  has  now  been  perfectly  well  for  many  years,  and, 
indeed,  after  the  first  eighteen  months  had  no  symp- 
toms upon  her  person  except  an  occasional  small 
mucous  patch  in  her  mouth. 


—  53  — 

Long  before  her  disease  was  well,  she  had  dis- 
carded her  lover,  and  tried  to  force  herself  to  the  con- 
viction that  she  was  sound  in  health. 

Now,  let  lis  suppose,  a  supposition  that  is  entirely 
a  possibility,  that  during  the  second  year  after  her 
chancre  she  had  married,  and  let  us  further  suppose 
that  her  husband  had  had  syphilis  ten  years  previous- 
ly, what  would  have  been  the  result?  Assuredly,  a 
syphilitic  child,  a  (seemingly)  healthy  mother,  and 
the  source  of  disease  imputed  to  the  old  and  extinct 
syphilis  of  the  father.  Fortunately,  in  this  instance 
there  has  been  no  marriage. 

The  other  case  in  point  is  this:  A  gentleman 
came  to  me  with  a  syphilitic  child,  the  disease  said  to 
have  been  contracted  from  a  wet  nurse  in  the  South. 
He  also  was  syphilitic,  the  source  of  his  malady  being 
imputed  to  the  child.  The  mother  seemed  to  be  a 
blooming  specimen  of  most  perfect  health. 

After  a  year  these  people  came  back  to  me  from 
the  South,  bringing  a  new  baby  which  was  manifestly 
syphilitic.  It  had  extensive  mucous  patches  on  its 
lips  and  was  being  suckled  by  a  wet  nurse  to  whom  it 
had  given  chancre  of  the  nipple,  which  chancre  I  saw 
and  treated. 

The  mother  was  still  in  blooming  health  and  de- 
clared that  she  was  not,  and  never  had  been  ill.  I 
kept  her  in  town  for  some  time  under  close  observa- 
tion, and  finally  was  rewarded  by  detecting  in  her 
mouth  a  full  crop  of  mild  mucous  patches,  and  dis- 


—  54  — 

covering  upon  her  entire  body  a  marked  fine  maculo- 
papular  syphilitic  eruption,  accompanied  by  some 
moderate  glandular  engorgements. 

I  showed  her  'these  symptoms  and  assured  her 
that  she  also  was  syphilitic,  but  she  would  not  believe 
me.  She  asserted  that  the  mouth  spots  were  caused 
by  indigestion,  and  the  eruption  by  the  warm  weather. 
She  took  a  few  mercurial  pills  at  my  earnest  solicita- 
tion, always  under  protest,  but  she  soon  ceased  taking 
them,  declaring  that  she  was,  and  always  had  been 
well.  She  had  no  anaemia,  no  headache,  no  loss  of 
hair;  positively  nothing  except  her  short-lived  crop  of 
mucous  patches  with  the  eruption,  which  were  as 
brilliantly  pathognomonic  as  any  possible  array  of 
more  prolonged  symptoms. 

Her  child  died  syphilitic.  Later  she  had  an- 
other which  never  had  eruptions  but  died  suddenly  in 
convulsions.  Then  a  child  which  had  some  muscular 
atrophies  but  still  lives  although  an  imperfect  speci- 
men physically  speaking. 

Finally  a  child  in  perfect  health.  All  this  took 
place  without  treatment,  the  mother  asserting,  her 
confidence  in  the  fact  that  she  was  not,  and  never  had 
been  diseased.  Had  I  not  had  the  good  fortune  to 
catch  her  in  her  one  mild  eruptive  demonstration  of 
disease,  it  would  have  been  impossible  for  me  to  have 
asserted  that  she  was  syphilitic,  but  she  certainly  was 
so,  and  had  she  nursed  her  children  she  would  surely 
have  demonstrated  Colles's  law,  that  a  syphilitic  child 


—  55  — 
cannot  give  chancre  of  the  nipple  to  the  mother  who 
nurses  it. 

I  might  still  further  multiply  instances,  but  these 
two  cover  a  greater  part  of  the  ground — and  this 
pamphlet  does  not  aim  to  be  controversial. 

But  to  return  to  the  question  of  scrofula. 
Scrofula  is  a  tubercular  malady.  A  patient  with 
syphilis  may  himself  have  also  scrofula,  or  his  wife 
may  have  it  and  show  no  visible  sign.  The  issue  of 
such  parents  may,  of  course,  be  scrofulous,  and  pos- 
sibly, if  the  condition  of  the  parents  was  low  in  a 
general  way,  ■  because  of  syphilitic  disease  at  the 
moment  of  conception  or  during  gestation,  the  child 
is  more  liable  to  show  scrofulous  symptoms  than  if 
the  parents  had  been  in  better  condition,  but  I  do  not 
believe  that  because  of  syphilis  the  child  will  be  any 
more  scrofulous  than  if  the  parents  at  the  time  of 
conception,  and  during  gestation,  had  suffered  from 
ship-wreck,  privation,  stravation,  bad  hygiene,  ma- 
laria, or  any  other  debilitating  condition. 

Certain  ulcers  and  bone  and  skin  diseases,  and 
glandular  enlargemeuts  in  children  of  syphilitic 
parents,  are  certainly  called  scrofulous,  but  they  get 
well  under  anti-syphilitic  medication  if  at  all — a  fact 
that  cannot  be  asserted  of  true  scrofulous  conditions 
of  apparently  similar  character  but  of  tubercular 
nature. 

Syphilis  might  be  wiped  out  from  the  face  of  the 
earth,  such,  at  least,  is  my  personal  belief  from  what  I 


-  56  - 

have  seen,  and  scrofula  would  flourish  none  the  less. 
Cod-liver  oil,  tonics,  iron,  and  hygienic  surroundings, 
may,  and  do  also,  more  or  less,  improve  the  physical 
condition  of  the  syphilitic  child,  but  this  by  no  means 
proves  that  its  malady  is  scrofulous — for  the  same 
medicines,  hygienic  and  dietetic  means,  are  equally 
valuable  to  the  broken-down  syphilitic  who  has  ac- 
quired his  disease  in  the  usual  way. 


FALLACY  NO.  XIII. 

The  Hot  Springs  of  Arkansas  have  some  especial  effect  in 
modifying  the  syphilitic  poison,  curing  the  disease,  or  at 
least  shortening  its  duration. 

This  fallacy  is  very  widespread,  but  I  believe  it 
to  liave  no  foundation  in  fact.  The  Hot  Springs  have 
a  certain  positive  value,  in  my  opinion,  bnt  it  is  not 
this.  I  visited  the  Springs  some  years  ago,  and  talked 
with  many  of  the  physicians  who  lived  there.  I  re- 
mained ten  days,  aud  accumulated  considerable 
information.  I  have  seen  a  great  number  of  syphil- 
itics  who  at  one  time  or  another  in  their  malady  have 
been  to  the  Springs.  I  have  sent  a  number  of  patients 
to  the  springs  myself,  and  I  have  seen  incalculable 
benefit  derived  from  their  treatment  at  that  place.  I 
have  advised  large  numbers  of  other  syphilitics  not 
to  go  to  the  Springs.  I  have  done  this  honestly  and, 
I  believe,  to  their  advantage. 

I  have,  therefoie,  some  definite  views  upon  the 
subject;  views,  I  believe,  not  biased  by  prejudice, 
and  these  I  shall  proceed  to  unfold,  for  I  believe  a 
correct  idea  of  what  may  be  expected  from  the 
springs  is  a  desideratum.  If  I  am  wrong  in  my  con- 
clusions I  regret  it,  and  can  only  state  in  justifica- 
tion that  I  have  used  all  the  common  sense  I  happen 
to  possess,  aided  by  personal  inspection  and  much 
evidence  derived  from  the  observation  of  patients,  in 
reaching  my  conclusions. 


-  58  - 

To  begin  with,  when  I  was  on  the  spot,  I  soon 
learned  that  there  was  no  common  consent  among 
the  physicians  practicing  there  as  to  either  what  it 
was  in  the  Springs  that  did  the  good,  or  the  manner 
in  which  the  supposed  therapeutic  agent  acted. 

One  thought  it  was  the  heat,  another  magnetism, 
another  electricity,  another  silicon  in  solution.  Most 
believed  that  there  was  real  virtue  in  the  water;  but 
one  gentleman  of  very  high  position  and  experience 
there,  assured  me  that,  in  his  opinion,  there  was  really 
nothing  of  any  value  in  the  Springs;  that  the  hot- 
water  was  like  any  other  hot-water,  and  that  the 
reason  why  patients,  as  a  rule,  did  better  in  regard  to 
their  symptoms  at  the  Hot  Springs  than  at  home,  was 
because  they  came  to  the  Springs  frightened  and  de- 
termined to  make  a  serious  effort  to  throw  off  their 
malady;  therefore,  they  obeyed  instructions,  took 
their  medicines  as  ordered,  gave  up  tobacco  and  alco- 
hol, took  a  proper  diet  and  exercise,  rested  their 
nerves,  and  kept  proper  hours.  He  assured  me,  also, 
that  it  was  his  belief  that  if  the  same  patients  would 
do  the  same  things,  including  the  use  of  common  hot- 
water,  at  home,  they  would  do  equally  as  well  as  at 
the  Springs. 

This  may  seem  like  a  startling  statement,  coming 
from  a  man  in  high  position,  of  large  experience  and 
very  successful  with  his  patients  at  the  Springs. 

There  are  a  number  of  springs  on  the  spot,  along 
the  main  avenue  of  the  town.     They  are  alleged  to 


—  59  — 

contain  'various  ingredients  in  different  proportions 
in  the  varying  springs, —iron,  sulphur,  etc., — but  in 
truth  they  are  all  remarkably  weak  in  mineral 
ingredients;  and,  to  my  mind,  it  is  exceedingly  doubt- 
ful whether  any  of  the  salts  they  do  contain  possess 
the  least  value  in  effecting  what  the  water  is  sup- 
posed to  effect. 

This  may  be  made  more  clear  when  I  state  the 
fact  that  the  water  of  one  of  the  most  popular  springs 
is  used,  when  cold,  for  ordinary  drinking  water  at  the 
table  of  one  of  the  largest  hotels.  It  is  as  clear  as  a 
crystal,  and  absolutely  without  medicinal  effect  of 
any  sort  or  description  that  I  could  discover — being 
in  fact  an  admirably  pure  drinking  water. 

Another  evidence  going  to  show  that  there  is 
nothing  in  the  mineral  composition  of  the  water  that 
possesses  value,  is  the  fact  that  nobody  pretends  to 
bottle  it  for  export,  or  to  assume  that  it  has  any  value 
—  except  when  used  directly  at  the  springs. 

When  the  water  is  hot,  however,  as  it  flows  out 
of  the  rock,  it  has  certain  peculiar  properties,  some 
of  which  I  personally  tested,  and  it  is  in  the  value  of 
this  heat,  as  above  other  heat,  that  the  quality  of  the 
water,  as  a  healing  agent,  is  by  most  people — and  I 
agree  with  them — believed  to  reside. 

All  sorts  of  assertions  are  made  about  the  heat 
of  this  water,  which  I  did  not  test  because  I  consid- 
ered them  unimportant.  For  instance,  it  is  alleged 
that  if  water  be  caught  in  a  vessel   as  it  pours   from 


—  6o  — 

the  rock,  and  its  deat  accurately  tested  by  a  ther- 
mometer, and  in  a  similar  vessel  other  common  water 
be  placed  which  has  been  brought  by  boiling  to  ex- 
actly the  same  degree  of  heat — and  then  these  two 
vessels  be  placed  side  by  side  under  similar  circum- 
cumstances, — that  the  hot-spring  water  will  lose  its 
temperature  very  much  more  rapidly  than  the  arti- 
ficially heated  water,  down  to  a  certain  point,  after 
which  the  artificially  heated  water  when  it  catches  up 
with  the  natural  specimen  in  its  loss  of  heat,  will 
cool  faster  than  the  spring  water;  in  short,  the  spring 
water  loses  heat  rapidly  at  first,  then  retains  what  is 
left  a  long  time,  in  this  way  not  acting  like  common 
hot  water. 

It  is  also  alleged  of  the  Hot  Springs  water,  that 
if  a  wire  be  thrust  up  the  small  stream  into  the  rock, 
enough  electrical  current  comes  through  it  to  deflect 
the  needle.  It  is  stated  also  that  the  clean,  bright 
blade  of  a  knife  may  be  magnetized  by  holding  it  in 
the  current  of  the  running  hot  water. 

All  these  things  I  do  not  know  from  personal 
experiment,  because  I  did  not  think  it  worth  while  to 
investigate  them,  but  I  did  look  into  the  action  of  the 
water  in  a  practical  way,  and  I  promptly  convinced 
myself  that  its  quality  of  heat  was  not  the  quality  of 
heat  of  ordinary  hot  water.  For  instance,  the  hot 
bath  that  one  takes  at  the  Springs  is  not  from  the 
water  as  it  runs  out  of  the  hill-side.  A  quantity  of 
this  water  is  collected  in  a  reservoir,   where  it  cools. 


—  6i  — 

and  this  cooled  water  is  mingled  with  the  hotter 
natural  current  until  a  bath  is  prepared  at  98°  F. 
This  temperature  of  water,  as  an3''one  may  readily 
convince  himself,  is  not  very  hot.  One  may  take  at 
home  a  bath  of  98°  F.,  and  not  be  over-heated  by  it, 
even  if  he  drinks  some  water  as  hot  as  he  can  sip  it  at 
the  time.  But  the  result  is  totally  different  at  the 
Springs.  Here  one  lies  in  his  bath  at  98°  F.,  and  sips 
a  little  hot  water,  which  the  attendant  hands  him, 
and  presently,  as  he  lies  in  the  bath,  the  whole  head 
and  face  breaks  out  into  a  profuse  perspiration,  the 
drops  running  off  his  hair  and  trickling  down  in  a 
stream  from  end  of  his  nose — at  least  such  was  the 
effect  upon  me. 

I  did  not  sit  in  the  sweating  room,  but  I  entered 
it,  and  saw  others  sitting  about  in  blankets  and  drink- 
ing hot  water,  with  pools  of  sweat  running  off  them, 
an  effect  which  cannot  be  reproduced  in  Ne\f  York 
by  the  employment  of  ordinary  hot  water  in  the  same 
way. 

Another  curious  result  which  I  observed  to  fol- 
low the  hot  bath  was  a  sense  of  general  exhiliration. 
Ordinarily,  when  one  takes  a  hot  bath,  the  immediate 
result  is  soothing  rather  than  depressing.  The  ten- 
dency is  to  lie  down,  perhaps  to  sleep.  Not  so  after 
the  Hot  Springs  bath.  The  individul  is  a  little  keyed 
up  by  the  bath.  He  passes  immediately  after  it, 
without  any  special  protection,  from  the  bath  house 
to  his  hotel.     I  did  this  without  any  idea  of  the  pos- 


—    62     — 

sibility  of  catching  cold.  I  found  that  the  tendency 
was  to  sing  or  to  whistle,  to  walk  briskly,  and  to  go 
up  the  hotel  stairs  two  steps  at  a  time.  About  a 
couple  of  hours  later,  however,  reaction  came  on. 
Then  there  was  experienced  a  certain  languor  with 
moderate  depression  and  tendency  to  sleep. 

These  effects  have  not  been  noticed  in  my  own 
person  as  the  ordinary  sequences  of  a  hot  bath. 

Finally  a  demonstration  of  the  rapid  giving  up 
of  its  heat  which  this  water  seems  to  possess  is  this: 
I  placed  a  board  across  a  bath-tub  and  sat  upon  it. 
Then  I  allowed  water  to  run  from  the  two  faucets, 
the  hot  and  cold,  into  the  tub  to  a  depth  of  almost 
four  inches  and  mixed  them  well  until  the  tempera- 
ture of  the  water  was  iio°  F.  Then  I  endeavored 
to  take  a  foot  bath  but  found  it  impossible,  the  foot 
could  not  tolerate  the  heat  of  the  water  for  a  longer 
time  than  perhaps  a  second,  after  which  the  scalding 
pain  made  it  necessary  to  withdraw  the  foot.  I  there- 
fore took  my  foot  bath  by  plunging  first  one  and  then 
the  other  foot  into  the  scalding  water,  retaining  it 
there  as  long  as  was  possible,  then  withdrawing  it  for 
a  moment  and  plunging  it  in  again.  With  this  alter- 
nating movement  I  took  my  foot  bath,  meantime 
holding  a  clinical  thermometer  in  my  mouth.  I'he 
room  was  only  moderately  warm.  The  thermometer 
in  my  mouth  was  raised  to  103°  F. 

At  home  I  repeated  the  same  experiment  with 
Croton  water.     I  found  it  possible  to  take  a  hot  foot 


_  63  - 

bath  keeping  both  feet  continuously  in  the  bath  when 
the  temperature  of  the  water  was  114°  F.  A  ther- 
mometer held  in  my  mouth  during  this  test  marked 
normal.  A  full  prolonged  hot  bath  at  104°  F.  only 
made  the  face  slightly  moist.  No  drops  collected. 
Surely  this  is  a  decided  difference,  and  I  think  estab- 
lishes the  fact  that  it  is  the  peculiar  quality  of  the 
heat  in  the  water  that  accomplishes  whatever  it  is 
that  the  water  effects. 

The  actual  stimulating  properties  of  the  water  I 
heard  much  comment  upon;  but  I  did  not  have  an 
opportunity  to  verify  the  statements.  I  was  told  that 
the  baths  aggravated  acute  disturbances,  and  intensi- 
fied acute  rheumatism,  while  they  bettered  the  chronic 
forms.  A  fomentation  with  the  natural  hot  water  up- 
on an  acute  abscess  instead  of  soothing  it  was  said  to 
cause  acute  pain  and  to  be  unbearable.  Malarial  at- 
tacks were  said  to  be  intensified  by  the  baths,  and 
acute  tubercular  troubles  also  made  worse.  It  was 
said  that  old  ladies  past  the  change  of  life,  coming  to 
the  springs,  sometimes  again  saw  their  menstruation 
return. 

All  forms  of  chronic  ulcers  seemed  forced  more 
or  less  into  granulating  under  the  stimulation  of 
the  prolonged  contact  with  the  water  moderately 
hot,  and  this  was  said  to  be  as  true  of  the  chronic 
varicose  ulcer  as  of  the  scrofulous  ulcer,  or  the  old 
syphilitic  ulcer. 

The  direct  influence  of  large  doses   of   the  hot 


—  64  — 

water  seemed  to  be  to  act  as  a  diaphoretic,  a  distinct 
diuretic,  and  apparently  somewhat  as  a  tonic  and  ap- 
petizer, none  of  which  qualities  remained  with  the 
water  after  it  had  become  cold.  I  did  not  personally 
observe  any  cathartic  effect. 

Now,  I  think  that  all  these  peculiarities  of  the 
water  distinguish  it  from  ordinary  hot  water.  That 
ordinary  hot  water  possesses  some  of  them  in  a  mod- 
erate degree  I  grant.  I  had  a  patient  with  a  very 
obstinate  ulcer  on  the  back  of  his  wrist.  He  was  too 
poor  to  go  to  Arkansas.  His  specific  doses  of  mer- 
cury and  the  iodides  did  not  cure  him,  so  I  put  him 
upon  the  Hot  Springs  method  at  home,  with  ordinary 
hot  water  in  all  its  forms,  baths  and  prolonged  local 
fomentations.  He  recovered  and  his  ulcer  healed — 
but  it  stayed  well  only  for  a  few  months.  So  con- 
vinced was  he,  however,  of  the  value  of  the  new  effort, 
that  upon  his  relapse  he  got  together  enough  funds 
to  go  to  the  Hot  Springs,  where  he  finally  became, 
and  remained,  entirely  well. 

What  then  is  the  value  of  the  Springs?  I  think 
it  is  this,  that  by  reason  of  the  diuretic  and  diaphoretic 
action  of  the  water,  a  patient  properly  managed  may 
take  at  the  Springs,  vastly  more  mercury  and  iodide 
of  potassium  without  being  either  salivated  or  iodized, 
than  he  can  at  any  other  spot  upon  the  face  of  the 
earth  with  which  I  am  familiar,  and  thus  the  medi- 
cines, not  the  Springs  directly,  cure  him. 

If  this  is  a  fact,  and  I  believe  it  to  be  so,  the  Hot 


-  65  - 

Springs  possess  very  great  value,  and  can  be  used 
when  required  for  emergencies. 

Ordinarily  there  is  no  object  in  running  up  mer- 
cury to  a  high  dose,  and  the  use  of  iodides  beyond 
the  point  at  which  they  fully  control  the  symptoms  is 
not  only  not  necessary,  but  even  harmful;  perhaps  it 
is  better  to  say  dangerous.  Commonly,  in  the  begin- 
ning, the  middle,  and  the  end  of  treatment,  there  is  no 
occasion  whatsoever,  to  push  either  mercury  or  the 
iodides  to  the  point  of  tolerance.  In  a  great  majority 
of  the  cases  in  which  it  does  become  imperative  to 
push  either  mercury  or  the  iodides  to  the  point  of 
tolerance,  it  may  be  done  just  as  well  at  the  patient's 
home  as  anywhere  else.  There  is  no  call  or  occasion 
for  the  assistance  of  the  Hot  Springs  influence,  and 
the  patient  most  certainly  does  equally  well  without 
it;  but  there  are  occasions,  and  they  are  grave  ones, 
when  it  is  life  or  death,  when  an  important  function 
hangs  in  the  balance,  when  the  physician  conversant 
with  the  treachery  and  possible  reach  of  syphilitic 
lesions  feels  that  he  owes  it  to  his  patient,  owes  it  to  his 
own  honesty  as  a  guardian  of  the  health  of  whomso- 
ever it  may  be  who  puts  confidence  in  him,  to  bend 
his  energies  to  the  work,  and  crowd  in  the  specific 
medication  in  doses  capable  of  overwhelming  the 
lesions  which  he  is  attacking. 

If  the  patient's  vitality  does  not  hold  up  under 
the  weight  of  the  combination  of  disease  and  heavy 
dosing,  if  the  stomach  gives  out,  then,  and  then  only, 

6  LL 


—  66  — 

I  think  is  the  time  to  send  a  patient  to  the  Hot 
Springs. 

The  physician  is  in  the  position  of  one  who  sees 
a  child  struggling  in  the  water.  If  the  child  can 
swim  a  little,  or  if  its  clothing  holds  it  up  and  the 
water  is  still,  the  rescuer  may  calmly  walk  out,  swim 
out,  or  take  a  boat  and  row  out,  to  pick  up  the  child. 

This  is  like  what  happens  in  ordinary  manage- 
ment of  syphilis. 

But  if  one  stands  by  a  mill-race  and  sees  a  child 
whirling  toward  him  in  the  water  and  about  to  go 
over  the  wheel,  he  must  act  boldly  and  without  fear 
of  consequences,  or  be  recreant  to  his  trust.  If 
nothing  better  is  at  hand,  it  is  his  plain  duty  to  grasp 
a  boat-hook  and  fish  out  the  child  by  its  clothing,  if 
possible;  and  if  m  his  effort  he  dislocates  a  joint, 
breaks  a  bone,  or  tears  the  flesh,  but  saves  the  child, 
he  has  done  his  manifest  duty.  The  Hot  Springs  for 
the  syphilitic  patient  sometimes,  in  my  opinion, 
makes  the  difference  between  the  clothing  and  the 
limb.  They  may  save  the  patient  unharmed,  when 
the  physician  could  only  pull  him  through  without 
them  at  the  ultimate  expense  of  tissue  or  function. 

I  have  quite  an  array  of  cases  which,  to  my  satis- 
faction, demonstrate  this  fact.  I  shall  detail  only 
two  of  them — although  the  experience  has  been 
repeated  for  me  more  or  less  brilliantly  many  times. 

A  gentleman,  suffering  from  syphilitic  symptoms, 
was  sent  to  me  by  a  physician  because  the   latter 


-  67  - 

could  not  manage  the  case  satisfactorily.  This  pa- 
tient had  had  a  brother  who  had  died  syphilitic  some 
years  previously,  of  what  was  called  softening  of  the 
brain — although  he  was  only  in  early  middle  life.  I 
treated  this  gentleman  to  the  best  of  my  ability,  and 
he  got  on  sometimes  well,  sometimes  badly,  for  a  long 
number  of  months — but  he  was  never  quite  satisfac- 
tory, either  to  himself  or  to  me.  He  finally  concluded 
to  consult  a  very  prominent  specialist  in  nervous  dis- 
eases, and  under  his  management,  as  usual,  did  well 
and  badly,  until  he  concluded  to  return  to  me. 

I  resumed  my  efforts  and  got  him  into  a  fair  con- 
dition, when  the  time  arrived  for  me  to  take  a  vaca- 
tion in  Europe,  and  I  instructed  the  patient  to  keep 
under  the  care  of  my  assistant  during  my  absence. 

Some  time  after  my  return  home,  I  learned  from 
a  relative  of  the  patient,  that  the  latter,  when  I  went 
away,  concluded,  that  as  he  had  been  long  ill  and  had 
not  recovered  under  my  advice  and  that  of  other 
competent  practitioners  of  regular  medicine,  he  would 
do  well  to  make  a  change,  so  he  put  himself  under 
the  charge  of  a  homoeopath  in  high  standing  in  the 
community. 

The  homoeopath,  of  course,  assured  him  that  his 
nervous  symptoms  were  not  syphilitic,  that  they  were 
due  to  the  fact  that  he  had  been  over-dosed  with 
mercury,  and  particularly  with  the  iodide  of  potas- 
sium, and  so  commenced  to  dose  him  with  minute 
pills  and  powders,  the  nature  of  which  I  did  not  think 
it  worth  while  to  inquire  into. 


—  68  — 

The  result  was  disastrous.  All  the  symptoms 
became  rapidly  worse.  The  occular  muscles  became 
involved,  the  eyes  crossed,  paralysis  of  the  left  side 
came  on,  and  the  brain  utterly  gave  out  with  symp- 
toms of  moderately  acute  mania. 

Then  his  homoeopathic  adviser  gave  a  fatal 
prognosis,  told  the  family  that  the  case  was  one  of 
softening  of  the  brain,  and  practically  deserted  the 
case. 

When  I  resumed  charge,  the  patient  was  in  a 
pitable  condition — a  physical  wreck.  I  employed  in 
his  case  every  expedient  with  which  I  was  familiar — 
dietetic,  hygienic,  therapeutic — and  endeavored  to 
make  up  for  lost  ground,  but  without  success.  No 
method  that  I  could  devise  succeeded  in  raising  his 
dose  of  the  iodide  of  potassium  beyond  three  hun- 
dred grains  a  day,  and  this,  while  it  upset  his  stomach 
and  overwhelmed  him  with  iodism,  failed  to  control 
his  progressive  symptoms;  his  mania,  his  paralysis, 
his  occular  symptoms,  persisted,  became,  indeed, 
aggravated,  while  his  general  physical  state  de- 
teriorated. 

Under  these  circumstances,  I  recognized  that  the 
time  had  come  for  a  final  effort,  and  I  insisted  that 
the  Hot  Springs  must  be  tried.  The  patient  was 
taken  by  a  relative  and  a  trained  nurse  to  Arkansas. 
There  he  was  put  under  the  usual  treatment,  baths, 
heavy  mercurial  inunctions,  and  progressively  in- 
creasing doses  of  the  iodide   of   potassium.     He  at 


-  69  - 

first  slowly,  then  rapidly,  improved.  He  appropriated 
through  his  skin  several  ounces  of  mercurial  ointment 
without  becoming  saturated,  and  his  dose  of  iodide 
of  potassium  was  run  up  to  eight  hundred  grains  a 
day — a  thing  which  I  had  found  absolutely  impossible 
in  New  York. 

He  returned  home  after  a  time  with  his  malady 
arrested,  but  still  with  a  brain  incapable  of  the  least 
exertion,  and  it  required  several  years  of  rest  and 
persevering  effort  to  re-establish  his  health.  He  had 
to  give  up  his  business  absolutely  for  a  considerable 
time,  but  finally  he  was  rewarded.  To-day  he  is 
practically  a  well  man,  and  has  long  since  left  off  all 
specific  medication.  His  eyes  are  straight  and  his 
vision  normal,  he  has  no  paralysis,  he  has  returned  to 
active  business  life,  and  is  little  else  than  a  resurrec- 
tion. Had  it  not  been  for  the  Hot  Springs,  I  believe 
that  he  would  have  been  food  for  worms  long  before 
this,  or  a  vegetable  in  human  form  without  intelli- 
gence. 

In  another  instance  a  gentleman  whom  I  saw  out 
of  town,  had  been  so  far  given  up  that  the  wood  out  of 
which  his  coffin  was  to  be  made  had  been  selected; 
since  he  lived  far  from  a  city  and  out  of  the  region  of 
anything  elegant  in  the  way  of  undertaker's  goods. 
He  was  paralysed,  bed-ridden,  kept  alive  only  by 
opium,  cocaine,  and  milk.  He  could  be  moved  only 
on  his  bed.  The  iodides  and  mercurials  had  failed. 
I  ordered  him  a  special  freight  car  and  had   him  put 


~  70  — 

into  a  bed  in  the  car  and  sent  with  a  physician  to  the 
Springs.  There  he  tolerated  the  mercury  and  enor- 
mous doses  of  iodides,  and  was  restored  to  many  years 
of  moderate  usefulness,  though  he  never  entirely  re- 
covered. 

So  much  for  the  possibilities  of  the  Hot  Springs 
in  some  desperate  cases.  All  the  bad  cases,  of 
course,  do  not  get  well  there.  The  disease  may  have 
advanced  too  far  for  any  medication  to  succeed.  We 
fight  disease,  not  death;  we  may  cure  an  ulcer  by 
medicine,  not  a  scar. 

Again  it  may  happen,  as  it  has  to  me  on  more 
than  one  occasion — though  such  cases  are  unusual — 
where  a  patient  failing  to  improve  at  the  Springs, 
manages  to  do  better  elsewhere.  A  most  striking  ex- 
ample of  this  occurred  under  my  observation  last  year. 
A  patient  in  very  advanced  syphilis,  cachectic,  and 
crippled  by  a  gummatous  knee-joint,  after  prolonged 
trial  at  the  Springs  gave  up  the  fight  there,  not  being 
helped,  and  was  brought  to  me  in  New  York  by  his 
physician.  We  both  concluded  that  his  case  was 
desperate,  nearly  hopeless,  yet  by  the  hypodermic  use 
of  mercury  (since  the  stomach  refused  it  and  inunc- 
tion had  failed)  coupled  with  great  attention  to  diet 
and  the  heroic  use  of  the  iodides,  I  was  enabled  to 
send  him  to  his  home  in  six  weeks  a  well  man.  He 
resumed  his  business,  and  when  I  last  heard  from 
him,  was  in  excellent  health. 

On  the  other  hand,  on  many  occasions  a  patient 


—  71  — 

has  been  seen  by  me  with  chancre,  and  on  learning 
the  nature  of  this  sickness  he  has,  either  from  his  own 
conviction  or  by  reason  of  the  solicitation  of  his 
friends,  fled  away  to  the  Hot  Springs.  These  patients 
I  have  seen  later  and  I  have  been  unable  to  observe 
that  their  malady  has  been  in  any  way  benefited  or  in 
the  least  curtailed  by  their  visit  to  Arkansas.  I  have 
also  treated  a  considerable  number  of  individuals 
who  had  made  one,  two,  three  and  more  visits  to 
the  Springs.  The  malady  goes  on  just  the  same. 
They  nearly  always  get  promptly  well  of  their  symp- 
toms when  they  go  to  the  Springs,  and  they  remain 
well  for  a  certain  time  afterwards,  but  other  symp- 
toms come  on  later,  and  they  find  out  generally  that 
so  far  as  being  radically  cured  at  the  Springs  is  con- 
cerned, they  have  had  their  labor  for  their  pains. 

I  feel  justified  in  giving  a  similar  opinion  about 
the  special  courses  at  Aix-la-Chapelle.  These  Springs 
do  not  cure  syphilis — no  springs  do  it.  Time  alone 
brings  the  malady  to^  an  end,  safely,  and  without 
leaving  serious  marks  behind  it,  in  the  vast  majority 
of  instances  where  patients  are  faithful  to  an  intelli- 
gently managed  prolonged  mercurial  treatment. 

That  a  given  case  may  not  get  well  and  entirely 
well  without  mercury  no  one  can  assert.  It  is  un- 
doubtedly true  that  a  man  may  cross  the  Atlantic 
Ocean  safely  in  a  small  boat — it  has  been  done — 
but  he  who  prefers  that  course  to  taking  a  regular 
liner  does  not  exhibit  any  remarkable  degree  of 
common  sense. 


PICHI 


(£--^Bx.A.3sr.£i.  ij>w£b:ric^^'x.a. 


AN    EMOLLIENT,  SEDATIVE,  AND    DIURETIC    IN    DISEASES 
OF  THE    URINARY  ORGANS. 


Of  the  remedies  which  have  recently  been  added  to  the  materia 
medica  none  so  thoroughly  as  Pichi  have  been  proven  to  possess  specific 
action  in  certain  hitherto  diflScultly  curable  conditions. 

Pichi  is  undoubtedly  a  valua:ble  sedative  and  emollient  in  inflamma- 
tion of  the  mucous  membranes  of  urinary  organs.  It  possesses  also 
considerable  diuretic  action. 

In  cases  of  vesical  catarrh,  acute  or  chronic,  following  a  mechanical 
cause,  such  as  gravel  or  calculus,  or  a' uric  acid  diathesis,  this  remedy 
will  .quickly  modify  the  urinary  secretion,  calm  the  irritability,  and  favor 
the  expulsion  of  the  gravel  and  calculi  'that  can  be  passed  through  the 
urethra. 

It  favorably  modifies  also  purulent  mucous  secretions.  Its  action 
on  affections  of  the  liver  must  be  attributed  to  its  diuretic^properties, 
though  it  is  recommended  for  icterus,  hydropsy,  and  dyspepsia  due  to 
insuflScient  biliary  secretions.  In  this  case  the  essential  oil,  when  ab- 
sorbed and  carried  into  circulation,  acts  as  a  stimulant  of  the  secretory 
apparatus  in  general,  but  the  specific  action  of  Pichi  is  directed  without 
doubt  upon  the  organs  of  the  urinary  apparatus. 

The  pharmaceutical  preparations  of  Pichi  are  as  follows: 

Fluid  Extract  and  Powdered  Extract  Pichi,  and  Soluble  Elastic  Cap- 
sules Pichi,  each  containing  four  grains  of  a  specially  prepared  extract, 
representing  the  active  medicinalj  constituents  of  thirty  grains  of  the 
drug. 

PARKE,  DAVIS  &  CO., 

DETROIT  AND  NEW  YORK. 


IN    EXPLANATION 

OF 


Tie  Plysicians'  Leisnre  Irary. 


We  have  made  a  new  departure  in  the  publication  of  medical  books.  As  you 
no  doubt  know,  many  of  the  large  treatises  published,  which  sell  for  four  or  five  or 
more  dollars,  contain  much  irrelevant  matter  of  no  practical  value  to  the  physi- 
cian, and  their  high  price  makes  it  often  impossible  for  the  average  practitioner  to 
purchase  anything  like  a  complete  library. 

Believing  that  short  practical  treatises,  prepared  by  well  known  authors,  con- 
taining the  gist  of  what  they  had  to  say  regarding  the  treatment  of  diseases  com- 
monly met  with,  and  of  which  they  had  made  a  special  study,  sold  at  a  small  price, 
would  be  welcomed  by  the  majority  of  the  profession,  we  have  arranged  for  the 
publication  of  such  a  series,  calling  it  Tlie  Physicians'  lieisure  Liibrary. 

This  series  has  met  with  the  approval  and  appreciation  of  the  medical  profes- 
sion, and  we  shall  continue  to  issue  in  it  books  by  eminent  authors  of  this  country 
and  Europe,  covering  the  best  modern  treatment  of  prevalent  diseases. 

The  series  will  oertairdy  afford  practitioners  and  students  an  opportunity 
never  before  presented  for  obtaining  a  working  library  of  books  by  the  best  authors 
at  a  price  which  p]ace><  them  within  the  reach  of  all.  The  books  are  amply  illtw- 
trated,  and  issued  in  attractive  form. 

They  may  be  had  bound,  either  in  durable  paper  covers  at  25  Cts.  per  copy, 
or  in  cloth  at  50  Cts.  per  copy.  Complete  series  of  12  books  in  sets  as  announced, 
at  $2.50,  in  paper,  or  cloth  at  $5.00,  postage  prepaid.     See  complete  list. 


PHYSICIANS'  LEISURE  LIBRARY 


PRICE!    PAPER,  25  CT?.  PER  COPY,  S2,50  PER  SET;  CLOTH,  50  CTS.  PER  COPY, 

$5.00  PER  SET. 


SERIES  I. 


nhalersi  Inhalations  and  Inhalants. 
By  Beverley  Robin'-on,  M.  D. 

The  Use  of  Electricity  in  the  Removal  of 
Superfluous  Hair  and  the  Treatment  of 
Various  Facial  Blemishes. 
By  Geo.  Henry  Fox,  M.  D. 

New  Medications,  in  2  Vols. 

By  Dujardin-Beaumetz,  M.  D. 

The  Modern  Treatment  of  Ear  Diseases. 
By  Samuel  Sexton,  M.  D. 

The  Modern  Treatment  of  Eczema. 
By  Henry  G.  Piflfard,  M.  D. 

Antiseptic  Midwifery. 

By  Henry  J.  Garrigues,  M.  D. 


On  the  Determination  of  the  Necessity  for 
Wearing  Glasses. 

By  D.  B.  St.  John  Roosa,  M    D. 

The  Physiological, Pathological  and  Ther- 
apeutic Effects  of  Compressed  Air. 
By  Andrew  H    Smith,  M.  O. 

G ran ularLid sand  ContagiousOphthalnriia. 
By  W.  F.  Mittendorf,  M.  D. 

Practical  Bacteriology. 

By  Thomas  E.  Satterthwaite,  M    D. 

Pregnancy,    Parturition,    the     Puerper«( 
State  and  their  Complications. 
By  Paul  F.  Mund?,  M.  D. 


SERIES   II. 


The  Diagnosisand  Treatment  of  Haemor- 
rhoids. 

By  Chas.  B.  Kelsey,  M.  D. 

Diseases  of  the  Heart,  in  2  Vols. 
By  Dujardin-Beaumetz,  M.  D. 
Translated  by  E.  P.  Hurd,  M.  D. 

The  Modern  Treatment  of  Diarrhoea  and 
Dysentery. 

By  A.  B     Palmer,  M.  D. 

Intestinal  Diseases  of  Children,  in  2  Vols. 
By  A.  Jacobi,  M.  D, 


The  Modern  Treatment  of  Headaches. 
By  Allan  McLane  Hamilton,  M.  D. 

The  Modern  Treatment  of  Pleurisy  and 
Pneumonia. 

By  G.  M.  Garland,  M.  D. 

Diseases  of  the  Male  Urethra. 
By  Fessenden  N.  Otis,  M.  D. 

The  Disorders  of  Menstruation. 
By  Edward  W.   Jenks,  M.  D. 

The  infectious  Diseases.  In2voto. 

By  Karl   Liebermeister. 
Translated  by  E.  P.  Hurd,  M.  D. 


SERIES  III. 


Abdominal  Surgery 

By  Hal  C.  Wyman,  M.  D. 

Diseases  of  the  Liver. 

By  Dujardin-Beaumetz,  M.D. 

Hysteria  and  Epilepsy. 

By  J.  Leonard  Coming,  M.  D. 

Diseases  of  the  Kidney. 

By  Dujardin-Beaumetz,  M.  D. 

The  Theory  and  Practice  of  the  Ophthal- 
moscope. 

By  J.   >ierbert  Claiborne,  Jr.,  M.  D. 

Modern  Treatment  of  Bright's  Disease. 
By  Alfred   L.    Loomis,    M.  D. 


D., 


Clinical  Lectures  on  Certain   Diseasss  of 
Nervous  System. 

By  Prof.  J.  M.  Charcot,  M.  D, 

The  Radical  Cure  of  Hernia. 

Bv  Henry  O.   Marcy,   A.  M.,  M. 
L.  L   D 

Spinal  Irritation. 

By  William  A  Hammond,  M.  D. 

Dyspepsia. 

By  Frank  Woodbury,  M.  D. 

The  Treatment  of  the  Morphia  Habit. 
By  Erlenmeyer. 

The  Etiologly,  Diagnosis  and  Therapy  of 
Tuberculosis. 

By  Prof.  H.  von  Ziemssen. 
Translated  by  D.  J.  Doherty,  M,  D. 


SERIES  m. 


Nervous  Syphilis. 

By  H.  C.  Wood,  M.  D. 

Education  and    Culture  as  correlated  to 
the  Health  and  Diseases  of  Women. 
By  A.  J.  C.  Skene,  M.  D. 

Diabetes. 

By  A.  H  Smith,  M.  D. 

A  Treatise  on  Fractures. 

By  Armand  L^espres,  M.  D. 

Some    Major  and    Minor   Fallacies  oon- 
cerning  Syphilis. 

By  E.  L.  Keyes,  M.  D. 

Hypodermic  Medication. 

By  Bourneville  and  Bricon. 


Practical  Points   in  the    Management  of 
Diseases  of  Children 
By  I.N    Love,  M.  D. 

Neuralgia. 

By   E.  P.  Hurd,  M.  D. 

Rheumatism  and  Gout. 

By  F.  Leroy  Satterlee,  M.  D. 

Electricity,  its  application  in  Medicine. 
By  Wellington  Adams,  M.  D. 

Taking  Cold. 

By  F.  H.  Bosworth,  M.  D. 

Auscultation  and  Percussion. 

By  Frederick  C.  Shattuck,  M.  D. 


B^rita  IV  will  h»  isatied  one  a  month,  beginning  ivith  N tvevnber,  1889. 


GEORGE  S.  DAVIS,  Publisher, 

E".  O.  Bo3=  -i'T'O.  IDetxoit,  I^Xloli. 


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